Retrospective analysis of post-hemorrhagic ventricular dilatation in very low birth weight infants, short and long-term outcome.
OBJECTIVE
The aim of this paper was to study the evolution of ventriculomegaly, the treatment and the developmental problems of a group of very low birth weight infants (VLBWI) born between 1985 and 1999 who met Levene's percentiles for post-hemorrhagic ventricular dilatation (PHVD).


METHODS
A retrospective hospital-based study of a cohort of 66 VLBWI who fulfilled the diagnostic criteria for PHVD was performed. Measures of neurodevelopmental outcome were evaluated by analyzing neurosensorial patterns as well as mental and behavioral adjustment up to pre-school age in 35 survivors.


RESULTS
The PHVDs initially (1985-1989) were due to a grade 4 intraventricular hemorrhage (IVH) (71.4%), and in the latter period (1995-1999) to IVH grade 2 (36.4%), grade 3 (31.8%) and grade 4 (31.8%). Acetazolamide has been used since the 90's in neonates with progressive PHVD. The 90s were characterized by an increasing incidence of tiny babies and rapidly-progressive PHVD. Taps were more frequent in the arrested dilatation group. Similarly, taps and acetazolamide were administered to newborns with persistent, slowly-progressive ventricular dilatation (PHVD > 4 weeks). The highest correlation was found for gestational age with the mental and psychomotor developmental indexes. Delayed performance and/or mental retardation were diagnosed in 71.4% of the survivors.


CONCLUSIONS
Acetazolamide and lumbar puncture, associated with other risk variables (severity of IVH, PHVD evolution and associated parenchymal lesions) are harmful in terms of development, but they have a role in the short-term arrested and slowly progressive PHVD of the surviving babies, and not in the mortality incidence. Our retrospective data demonstrated that lower gestational age at birth increased the risk of lower mental and psychomotor developmental indexes.
Neonatal Intensive Care Unit, Department of Pediatrics, University of Padua, Padua, Italy. zaramella@pediatria.unipd.it
P
P
Zaramella
P
P
Lago
F
F
Freato
N
N
Battajon
O S
OS
Saia
L
L
Chiandetti
D000086:Acetazolamide / Q000008:administration & dosage / Q000627:therapeutic use; D000367:Age Factors; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000150:complications*; D002552:Cerebral Ventricles / Q000473:pathology*; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D004108:Dilatation, Pathologic; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008607:Intellectual Disability / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors; D017287:Ventriculoperitoneal Shunt
D000927:Anticonvulsants; D000086:Acetazolamide