The continuing problem of post-hemorrhagic ventricular dilation in infants born prematurely

Abstract

In this volume of The Journal of Pediatrics, 3 articles are devoted to a life-altering condition in infants born prematurely: severe brain hemorrhage with post-hemorrhagic ventricular dilation (PHVD). Infants with extreme prematurity are particularly vulnerable to this condition and Shankaran et al assembled a cohort of 815 infants born in 2011-2015 at ≤26 weeks of gestation with PHVD and followed them to 18-26 months. The high rates of death or neurodevelopmental impairment reported in this cohort obligate us to find new approaches to help infants recover from severe brain injury and improve outcomes. One approach, intervention at lower thresholds of ventricular dilation was studied in the European ELVIS trial and Cizmeci et al report the long awaited 2-year outcomes of that study. Finally, El-Dib et al present a Medical Progress report on the pathophysiology of PHVD and proposed management strategies to promote better outcomes. Although we do not yet have all the evidence we need to ensure the best outcomes for infants with preterm birth and PHVD, progress can be made by focusing attention on this problem, increasing our understanding of its significance, sharing trial results globally, and developing innovative strategies for moving forward. Article pages 16, 28, and 36 ▸ Management of Post-hemorrhagic Ventricular Dilatation in the Infant Born PretermThe Journal of PediatricsVol. 226PreviewSevere forms of intraventricular hemorrhage (IVH) continue to occur in up to 15% of infants born extremely premature,1 and more than one-half of these infants develop post-hemorrhagic ventricular dilatation (PHVD).2 PHVD is a term that represents the progressive ventricular dilatation caused by IVH and encompasses other terms, such as post-hemorrhagic hydrocephalus. PHVD is associated with a high risk for subsequent adverse motor and cognitive neurodevelopmental outcomes. Despite many decades of investigations, there is no consensus among neonatologists, pediatric neurologists, and pediatric neurosurgeons as to the best management of PHVD. Full-Text PDF Randomized Controlled Early versus Late Ventricular Intervention Study in Posthemorrhagic Ventricular Dilatation: Outcome at 2 YearsThe Journal of PediatricsVol. 226PreviewTo compare the effect of intervention at low vs high threshold of ventriculomegaly in preterm infants with posthemorrhagic ventricular dilatation on death or severe neurodevelopmental disability. Full-Text PDF Outcomes Following Post-Hemorrhagic Ventricular Dilatation among Infants of Extremely Low Gestational AgeThe Journal of PediatricsVol. 226PreviewTo assess outcomes following post-hemorrhagic ventricular dilatation (PHVD) among infants born at ≤26 weeks of gestation. Full-Text PDF