For preterm newborns with hydrocephalus, decompression of ventricles using a temporary device is frequently the first neurosurgical surgery. After observing a subgroup of infants who had intraparenchymal hemorrhage (IPH) following serial ventricular reservoir taps, the authors attempted to characterize IPH and its relationship to neurodevelopmental outcome. In this multicenter case-control research, a gestational age-matched control with reservoir who did not develop IPH was chosen for each neonate with periventricular and subcortical IPH. The researchers looked at digital cerebral ultrasound (cUS) scans and term-equivalent age (TEA)–MRI (TEA-MRI) studies. Researchers took Ventricular measures before, 3 days after, and 7 days after the reservoir insertion. They calculated volume changes in the ventricles. They used Standardized assessments to examine neurodevelopmental outcomes at 2 years corrected age.
The study comprised 18 neonates with IPH (mean gestational age 30.0 ± 4.3 weeks) and 18 matched controls. Infants with IPH had a higher ventricular volume reduction than occipitofrontal head circumference following 7 days of reservoir taps (mean difference -0.19 [95% CI -0.37 to -0.004], p = 0.04). Infants with and without IPH had similar cognitive and motor Z-scores (mean difference 0.42 [95% CI -0.17 to 1.01] and 0.58 [95% CI –0.03 to 1.2]; p = 0.2 and 0.06, respectively). After controlling for age at the time of assessment, multifocal IPH was adversely linked with cognitive score (coefficient -0.51 [95% CI -0.88 to-0.14], p = 0.009) and ventriculoperitoneal shunt with motor score (coefficient -0.50 [95% CI -1.6 to -0.14], p = 0.02). The purpose of this study was the first to show that IPH can emerge in neonates with hydrocephalus after a rapid decline in ventricular capacity within the first week after serial reservoir taps are started. More research into using cUS to guide the amount of cerebrospinal fluid removed is needed.
Reference:thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/28/6/article-p695.xml
