Intraventricular Hemorrhage Complications Research Articles

The clinical effects of two non-invasive ventilation modes on premature infants with respiratory distress syndrome: A randomized controlled trial.

To compare the safety and effectiveness of nasal noninvasive high- frequency oscillatory ventilation (NHFOV) and duo positive airway pressure (DuoPAP) applications in preterm babies with respiratory distress syndrome (RDS). This was a randomized controlled trial. Forty-three premature infants with RDS treated in the neonatal intensive care unit of Huaibei Maternal and Child Health Hospital from January 2020 to November 2021 were selected as the research participants. They were randomly divided into the NHFOV group (n = 22) and DuoPAP group (n = 21). General conditions, including the arterial oxygen partial pressure (PaO2), carbon dioxide partial pressure (PaCO2), oxygenation index (OI), the incidence of apnea at 72 hours, duration of noninvasive respiratory support, maternal high-risk factors, total oxygen consumption time, total gastrointestinal feeding time, and the frequency of intraventricular hemorrhage (IVH), neonatal necrotizing enterocolitis (NEC), and bronchopulmonary dysplasia (BPD) and apnea were compared between the NHFOV group and DuoPAP group at 12 and 24 hours after noninvasive respiratory support. There was no noteworthy difference between the 2 groups with respect to PaO2, PaCO2, OI, IVH, and NEC and BPD at different nodes (all P > .05). The endpoints of PaO2, PaCO2 and OI and complications of IVH, NEC, BPD and Apnea, and did not reveal any statistical differences between NHFOV and DuoPAP during the respiratory support in preterm babies with RDS.

21 Spontaneous resolution of post-hemorrhagic ventricular dilatation in preterm newborns and neurodevelopmental outcomes

Abstract Background Post-hemorrhagic ventricular dilatation (PHVD) is a serious complication of intraventricular hemorrhage (IVH) in preterm newborns and is associated with significant impairments. The natural evolution of PHVD and developmental implications of spontaneous resolution are not well established. Objectives To investigate the natural evolution of PHVD and compare neurodevelopmental impairments in newborns with (1) spontaneous resolution of PHVD; (2) persistent PHVD and (3) PHVD who underwent neurosurgical intervention. Design/Methods We conducted a multicenter retrospective cohort study of 5238 newborns born at ≤34 weeks’ gestational age (GA) admitted to two tertiary Neonatal Intensive Care Units (NICU) between 2012 and 2020. Head ultrasounds (HUS) of 476 newborns with IVH grade ≥2 were reviewed to identify PHVD, defined as ventricular index (VI) >97th centile (p97) for GA and anterior horn width (AHW) >6mm on any HUS in the first 6 weeks of life. Newborns with PHVD were divided into three groups, Group 1: newborns with spontaneous resolution of PHVD, defined as the regression of both lateral ventricles below the VI and AHW thresholds, Group 2: newborns with persistent PHVD absent neurosurgical intervention and Group 3: newborns who underwent any neurosurgical intervention. Neurodevelopmental outcomes at 18 months corrected, obtained through chart review, were compared. Results Of 108 newborns with PHVD, 88 survived to NICU discharge (mean GA 28.4 weeks, SD 2.8; median age at PHVD diagnosis 8.0 days, IQR 5.0-12.8). Overall, 34/88 (38.6%) newborns had spontaneous resolution of PHVD (Group 1). The median time between PHVD diagnosis and spontaneous resolution was 14.0 days (IQR 6.8-32.3) (Figure). In Group 3, the median time between PHVD diagnosis and the first neurosurgical intervention was 14.0 days (IQR 7.0-23.0). Group 1 had significantly smaller maximal VI (1.8, 3.4, and 11.1mm above p97, p<0.001) and AHW (7.2, 10.8, and 20.3mm, p<0.001) than Groups 2 and 3, respectively, and were less likely to have bilateral PHVD (OR 0.47, 95% CI 0.33-0.67) than Group 3. Neurodevelopmental outcome data at 18 month were available for 53/88 (60.2%) survivors (Table). Group 1 had lower rates of cerebral palsy (17.4% vs 45.8%; p=0.037), global developmental delay (17.4% vs 50.0%; p=0.018), epilepsy (4.3% vs 29.2%; p=0.048) and involvement of ≥3 allied health professionals (34.8% vs 70.8%; p=0.013) compared to Group 3. Conclusion Newborns with PHVD without spontaneous resolution are at higher risk for significant neurodevelopmental impairments despite neurosurgical interventions, which may be due to more prominent ventricular dilatation. Strategies aimed at mitigating the burden of impairments in patients without spontaneous resolution are needed.

Analysis of Factors Associated With Body Mass Index at Ages 18 and 36 Months Among Infants Born Extremely Preterm

The development of neonatology has been associated with improved survival among infants born extremely preterm, and understanding their long-term outcomes is becoming increasingly important. However, there is little information on body mass index (BMI) among these children. To determine factors associated with BMI at ages 18 months and 36 months among infants born extremely preterm. This retrospective, multicenter cohort study was conducted using data from the Neonatal Research Network Japan database for 8838 infants born at gestational ages 23 to 28 weeks with data on BMI at 18 months and 36 months. Data were analyzed from April 2018 through June 2021. BMI and BMI z score at ages 18 months and 36 months were regressed with gestational age, intrauterine growth restriction (IUGR) status, and complications during pregnancy and the neonatal period separately by presence of multiple pregnancy and sex. BMI and BMI z score at ages 18 months and 36 months. Among 16 791 eligible infants born extremely preterm, 8838 infants were included in the analysis. There were 7089 infants born from single pregnancies (mean [SD] gestational age, 26.0 [1.6] weeks; 3769 [53.2%] boys; mean [SD] birth weight, 847 [228] g) and 1749 infants born from multiple pregnancies (mean [SD] gestational age, 26.3 [1.5] weeks; 903 [51.6%] boys; mean [SD] birth weight, 860 [217] g). In single pregnancies, every week of increased gestational age was associated with an increase in BMI of 0.21 (95% CI, 0.17-0.25) among boys and 0.20 (95% CI, 0.15-0.25) among girls at age 18 months and 0.21 (95% CI, 0.18-0.24) among boys and 0.21 (95% CI, 0.18-0.24) among girls at age 36 months. There was an interaction association between gestational age and IUGR among boys at age 36 months, with a decrease in the change associated with gestational age of 0.12 (95% CI, 0.05-0.19). Every week of increased gestational age in single pregnancies was associated with an increase in BMI z score of 0.14 (95% CI, 0.17-0.21) among boys and 0.17 (95% CI, 0.13-0.21) among girls at age 18 months and 0.19 (95% CI, 0.16-0.22) among boys and 0.17 (95% CI, 0.15-0.20) among girls at age 36 months. Among single pregnancies, IUGR was associated with a decrease in BMI among boys (0.59 [95% CI, 0.23-0.95]) and girls (0.75 [95% CI, 0.39-1.11]) and BMI z score among boys 0.85 [95% CI, 0.25-0.95)] and girls (0.67 [95% CI, 0.36-0.97] at age 18 months and BMI among boys (0.44 [95% CI, 0.17-0.18]) and girls (0.84 [95% CI, 0.55-1.12]) and BMI z score among boys (0.46 [95% CI, 0.21-0.71]) and girls (0.77 [95% CI, 0.53-1.01]) at age 36 months. In multiple pregnancies, IUGR was associated with a decrease in BMI z score at age 36 months among boys (0.26 [95% CI, 0.42-0.89]) and girls (0.29 [95% CI, 0.22-0.79]). In single pregnancies intraventricular hemorrhage (IVH) was associated with a decrease in BMI of 0.47 (95% CI, 0.21-0.73) among boys and 0.42 (95% CI, 0.13-0.71) among girls at age 18 months and 0.53 (95% CI, 0.32-0.74) among boys and 0.31 (95% CI, 0.07-0.54) among girls at age 36 months. IVH was associated with a decrease in BMI z score in single pregnancies of 0.63 (95% CI, 0.20-0.41) among boys and 0.35 (95% CI, 0.12-0.60) among girls at age 18 months and 0.53 (95% CI, 0.34-0.71) among boys and 0.30 (95% CI, 0.11-0.50) among girls at age 36 months. Similar associations were seen in multiple pregnancies. This study found that gestational age, the presence of IUGR and multiple pregnancy, and IVH complications were associated with infant BMI at ages 18 months and 36 months. These findings suggest that these complicating factors should be considered when setting growth targets and nutrition strategies for infants born extremely preterm.

Clinico-pathogenetic changes of complications of intraventricular hemorrhage in perinatal period among children in Uzbekistan

Clinico-pathogenetic changes of complications of intraventricular hemorrhage in perinatal period among children in Uzbekistan

Incidence and Severity of Intra-Ventricular Hemorrhage (IVH) in Preterm Infants, Northeast of Iran

Introduction: The incidence rate of Intra-Ventricular Haemorrhage (IVH) varies from 20% to 25% among preterm infants with a very low birth weight. IVH could compose critical disabilities which are directly associated to its grade. The aim of this study was to evaluate the incidence and severity of IVH in preterm infants referred to the academic Hospital of Gorgan, Northeast of Iran.Materials and Methods: In this cross-sectional study, we examined all preterm infants who had been referred to the academic Hospital of Gorgan, Northeast of Iran between Augusts 2014 and February 2015. Seventy one preterm infants (≤34 weeks of gestation, ≤1500g birth weight) have been included. Cranial ultrasound was done within 3-5 days of birth for all subjects and subsequent ultrasounds were performed based on their birth weight by portable ultrasound device.Results: The overall incidence of IVH was 64.8% in the present study. There was a significant relationship between IVH incidence and the gestational age (p=0.010). Also the lower birth weight was associated to the higher rate of IVH complications reported in sequential ultrasounds (p<0.05).Conclusion: Gestational age and birth weight seem to have key roles in the occurrence and severity of IVH, respectively.J Nepal Paediatr Soc 2016;36(1):38-41

The rationale for routine cerebral ultrasound in premature infants.

Premature birth is associated with brain lesionsmostly resulting from hypoxia-ischaemia and haemorrhage [1, 2]. Hypoxiaischaemia may give rise to periventricular leukomalacia (PVL) in either the focal form or the diffuse form [3]. Focal PVL is characterized by necrosis of all cell elements in the periventricular white matter, with the formation of cysts that progressively coalesce, resulting in ventricular enlargement with irregular outlines of the lateral ventricles and thinning of the periventricular white matter [3, 4]. Diffuse PVL is characterized by apoptotic cell death of the oligodendroglial precursors, resulting in hypomyelination and ventricular enlargement with regular outlines [3, 5]. An increased incidence (50%) of periventricular leukomalacia is reported in very-low-birthweight (≤1,500 g) premature infants, with the most severe cystic form representing only 5% [6]. Haemorrhagic lesions take the form of a continuum of germinal matrix haemorrhage, intraventricular haemorrhage and periventricular venous haemorrhagic infarction. The factors underlying the development of germinal matrix haemorrhage, which is apparently of venous origin, are increased vascularity, vascular immaturity and deficient autoregulation of cerebral blood flow [7]. Germinal matrix haemorrhage may progress to intraventricular haemorrhage, with or without ventricular dilatation. Periventricular haemorrhagic infarction is almost always associated with intraventricular haemorrhage, and compression of the paraventricular veins belonging to the deep Galenic system of drainage is thought to be the underlying cause [1, 2]. Germinal matrix haemorrhage with intraventricular haemorrhage occurs in 20% of very-low-birth-weight premature infants, while intraventricular haemorrhage associated with periventricular haemorrhagic infarction occurs in less than 5% of cases [6]. An increased incidence of periventricular haemorrhagic infarction is observed in infants with birth weight less than 750 g [6]. Post-haemorrhagic hydrocephalus, which can be communicating or non-communicating, is another complication of intraventricular haemorrhage [1, 2]. The incidence of posthaemorrhagic ventricular dilation is 36%, and this resolves in approximately 65% of cases [1]. Cerebellar abnormalities, mainly haemorrhage, infarction and underdevelopment, are being increasingly recognized and these have been associated with very low birth weight [4, 8]. Hemispheric haemorrhage, which is the most common cerebellar haemorrhagic lesion, is usually unilateral, starting in the external granular layer [8]. The less common vermian haemorrhage starts in the germinal matrix of the fourth ventricle [8]. The incidence of cerebellar haemorrhage is 17% in infants weighing less than 750 g and 2% in infants more than 750 g at birth [8]. Cerebellar infarction has been associated with supratentorial periventricular leukomalacia, and its reported incidence in an unselected population is 10–15% [9]. Underdevelopment is the most common cerebellar abnormality, for which the predisposing factors are extreme prematurity, very low birth weight, haemosiderin blood products, severe hypotension, large patent ductus arteriosus and transynaptic trophic effects [3]. Other acquired lesions of the premature brain are punctate white matter hyperintensities, perforator stroke and infectious lesions [10–12]. Punctate white matter hyperintensities are relatively common lesions (incidence 20%), occurring in the preterm period and decreasing in number at term-equivalent age [10]. Perforator stroke occurs in the distribution of lenticulostriate arteries, and in preterm neonates it is often subclinical [12]. Viral or fungal infections can affect the brain M. I. Argyropoulou (*) Department of Radiology, University of Ioannina Medical School, 45110 Ioannina, Greece e-mail: margyrop@cc.uoi.gr

Risk factors for post-hemorrhagic hydrocephalus among infants with intraventricular hemorrhage

Post-hemorrhagic hydrocephalus (PHH) is a common complication of intraventricular hemorrhage (IVH) of prematurity, but the risk factors that predispose infants with IVH to PHH have not been fully elucidated.

1075 Risk Factors for Posthemorrhagic Hydrocephalus in a Neonatal Intensive Care Unit

Background and aimPost-hemorrhagic hydrocephalus (PHH) is one of the most serious complications of intraventricular hemorrhage (IVH) in a newborn. Causes are multifactorial including genetical, pre and postnatal complications. Conditions assosciated...

Randomized Clinical Trial of Prevention of Hydrocephalus After Intraventricular Hemorrhage in Preterm Infants: Brain-Washing Versus Tapping Fluid

Hydrocephalus is a serious complication of intraventricular hemorrhage in preterm infants, with adverse consequences from permanent ventriculoperitoneal shunt dependence. The development of hydrocephalus takes several weeks, but no clinical intervention has been shown to reduce shunt surgery in such infants. The aim of this study was to test a new treatment intended to prevent hydrocephalus and shunt dependence after intraventricular hemorrhage. We randomly assigned 70 preterm infants who had gestational ages of 24 to 34 weeks and were progressively enlarging their cerebral ventricles after intraventricular hemorrhage to either (1) drainage, irrigation, and fibrinolytic therapy to wash out blood and cytokines or (2) tapping of cerebrospinal fluid by reservoir as required to control excessive expansion and signs of pressure (standard treatment). We evaluated outcomes at 6 months of age or hospital discharge (if later). Of 34 infants who were assigned to drainage, irrigation, and fibrinolytic therapy, 2 died and 13 underwent shunt surgery (dead or shunt: 44%). Of 36 infants who were assigned to standard therapy, 5 died and 14 underwent shunt surgery (dead or shunt: 50%). This difference was not significant. Twelve (35%) of 34 infants who received drainage, irrigation, and fibrinolytic therapy had secondary intraventricular hemorrhage compared with 3 (8%) of 36 in the standard group. Secondary intraventricular hemorrhage was associated with an increased risk for subsequent shunt surgery and more blood transfusions. Despite its logical basis and encouraging pilot data, drainage, irrigation, and fibrinolytic therapy did not reduce shunt surgery or death when tested in a multicenter, randomized trial. Secondary intraventricular hemorrhage is a major factor that counteracts any possible therapeutic effect from washing out old blood.

Cisterna magna clot and subsequent post-hemorrhagic hydrocephalus.

Posthemorrhagic hydrocephalus (PHH) is an ominous complication of intraventricular hemorrhage (IVH) in premature infants. Previous studies have correlated lateral intraventricular clot with subsequent PHH, but there are no studies assessing the outcome of clot in the cisterna magna (CM). The purpose of this study was to determine if the identification of clot in the CM on the initial positive cranial ultrasound for intraventricular hemorrhage increased the risk of subsequent PHH. A review of ultrasound records over a 4-year period identified 41 neonates with at least grade 2 IVH who had specific CM views prospectively performed. Thirty-six survived more than 3 months. Overall, 22 (61%) developed hydrocephalus. On the initial positive cranial ultrasound, CM blood was identified in 21 (58%). Of these 18 (86%) developed hydrocephalus [odds ratio (OR) 16.5, confidence interval (CI) 2.5-125.7, P < 0.001] and 14 (67%) required intervention or remained dilated (OR 28.0, CI 2.8-1265.8). All patients that required permanent shunt placement had initial CM clot (P < 0.01). Initial ventriculomegaly was not a significant predictor of subsequent hydrocephalus, but a dilated third ventricle (> or = 8 mm) was (OR 9.0, CI 1.2-103.3, P < 0.04). Asymmetric intraventricular clot filling of more than 50% was not predictive of hydrocephalus, but symmetric clot of more than 50% was (OR 10.8, CI 1.4-61.6, P < 0.01). Nine neonates had concomitant parenchymal damage with varying outcomes (three shunted, two persistent ventriculomegaly, four resolved with normal sized ventricles). In this study CM clot significantly increased the risk and was a better predictor of posthemorrhagic hydrocephalus than initial hydrocephalus.