Abstract
PurposePost-hemorrhagic hydrocephalus (PHH) is a rare but serious complication among premature babies in the neonatal intensive care unit. The causes of PHH are still not entirely understood, and its prevention and treatment are controversial. We tried to analyze the risk factors for such complication in our cohort.MethodsWe reviewed our neonatology data bank and included all preterms below 28 weeks who were born in the period between 1999 and 2014 and suffered from an intraventricular hemorrhage (IVH). We reviewed gestational age, gender, birth weight, type of birth, IVH degree, comorbidities, therapy, complications, time to event, protein content of cerebrospinal fluid, and clinical follow-up.ResultsWe identified 180 patients, divided into two subgroups, “B1” with 37 cases (IVH + PHH) and “B2” with 143 cases (IVH − PHH). In group B1, the presence of IVH grades I, II, III, or IV was in 11%, 19%, and 70% respectively. Nineteen patients were treated with a ventricular access device (VAD) or external ventricular drain (EVD). A total of 20 shunts were implanted, with 11 revisions (55%). One patient suffered from thrombocytopenia. In subgroup B2, 51% showed IVH grade I, whereas severe IVH grades were only present in 22%. 25.9% suffered from thrombocytopenia. Thrombocytopenia was significantly higher in patients who did not develop PHH (p value: 0.002).ConclusionAccording to our results, thrombocytopenia could play a decisive role in avoiding development of PHH as a sequel of IVH. We recommend a randomized controlled trial to assess the possible efficacy of antiplatelet drugs in avoiding PHH in this vulnerable group.
Highlights
Despite the enormous development of treatment options and an increase in prenatal diagnostic procedures, intraventricular hemorrhage (IVH) remains one of the most common complications in premature births [1]
Regarding the two groups who developed IVH, we found a marked increase in the incidence of thrombocytopenia in the group who did not develop Post-hemorrhagic hydrocephalus (PHH) in comparison with those who developed PHH 25.9% vs 2.7% (p value 0.002)
We found that the grade of intraventricular hemorrhage defines at utmost the incidence of development of post-hemorrhagic hydrocephalus
Summary
Despite the enormous development of treatment options and an increase in prenatal diagnostic procedures, intraventricular hemorrhage (IVH) remains one of the most common complications in premature births [1]. Preterms below the 28th week of pregnancy are called “extremely preterm” [10] This particular age group develops intraventricular bleeding with a probability of 15–20% [11]. A downward trend in the incidence of IVH has been described in recent decades [12], the incidence of PHH requiring treatment appears to remain constant and is described with a probability of 25–50% [13]. Despite this fact, no clear guidelines for the treatment of PHH until now have been described, even an optimal time for performing surgical measures is still debatable, and despite adequate therapeutic
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