Reader response: Posthemorrhagic ventricular dilatation in preterm infants: When best to intervene?

Abstract

I read with interest the article by Leijser et al.1 regarding management algorithm in preterm infants with posthemorrhagic ventricular dilation. The intraventricular hemorrhage indicates neuronal damage owing to its propensity for causing acute hydrocephalus due to clot, chronic hydrocephalus due to fibrosis, and impending neuronal damage due to vasospasm. Early intervention thereby assures early resolution of bleed, maintains patency of the normal CSF pathways, as well as prevents axonal stretch, thereby optimizing neuronal plasticity. So the burning issue is not in when and how to intervene, but how to foresee early neuronal damage following intraventricular bleed. In these aspects, inclusions of diffusion tensor imaging for early visualization of anisotropy within the periventricular tracks and usage of near-infrared spectroscopy may be of immense value in optimizing time of intervention.2 This approach would aid in early intervention, thereby better outcome, as justified by the authors.1