title: Timing of external ventricular drainage and neurodevelopmental outcome in preterm infants with posthemorrhagic hydrocephalus.
abstract: OBJECTIVE
  To delineate the impact of early (≤ 25 days of life) versus late (> 25 days) external ventricular drainage (EVD) on the neurodevelopmental outcome of preterm infants with posthemorrhagic hydrocephalus (PHH) following intraventricular hemorrhage (IVH).
  
  
  METHODS
  We retrospectively categorized 32 premature infants with PHH into two groups according to whether they underwent early (n = 10) or late (n = 22) EVD. We administered the Battelle Developmental Inventory II and a neuromotor examination (median age, 73 months, range: 29-100).
  
  
  RESULTS
  In adjusted comparisons, early EVD was associated with better scores than late EVD in adaptive (79 ± 22.6 vs. 58.8 ± 8.1, P = .01), personal social (90.7 ± 26 vs. 67.3 ± 15.9, P = .02), communication (95.4 ± 27.5 vs. 69.6 ± 20.5, P = .04) and cognitive (78.9 ± 24.4 vs. 60.7 ± 11.5, P = .055) functions. Three (30%) early EVD infants had severe (<2.5 standard deviation) cognitive disability compared to 18 (82%) late EVD infants (P = .03). The incidences of cerebral palsy and neurosurgical complications were equal for the two groups. Subgroup analyses suggested that early EVD was beneficial in infants with original grade III IVH (n = 15, P < 0.05), but that it had no beneficial effects in infants with prior parenchymal injury (n = 17, P = NS).
  
  
  CONCLUSIONS
  In this small retrospective series, early EVD is associated with lower rates of cognitive, communication and social disabilities than later EVD in infants with PHH without prior parenchymal injury. A randomized prospective trial is warranted.
authors.affiliation: Neonatal Neurology Service, Child Neurology and Development Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel. bassan@post.tau.ac.il
authors.forename: Haim
authors.initials: H
authors.lastname: Bassan
authors.forename: Rina
authors.initials: R
authors.lastname: Eshel
authors.forename: Inbal
authors.initials: I
authors.lastname: Golan
authors.forename: David
authors.initials: D
authors.lastname: Kohelet
authors.forename: Liat
authors.initials: L
authors.lastname: Ben Sira
authors.forename: Dror
authors.initials: D
authors.lastname: Mandel
authors.forename: Loren
authors.initials: L
authors.lastname: Levi
authors.forename: Shlomi
authors.initials: S
authors.lastname: Constantini
authors.forename: Liana
authors.initials: L
authors.lastname: Beni-Adani
mesh_terms: D001724:Birth Weight; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D018450:Disease Progression; D004322:Drainage; D005260:Female; D006257:Head / Q000033:anatomy & histology; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000523:psychology* / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal; D020300:Intracranial Hemorrhages / Q000150:complications*; D016015:Logistic Models; D008297:Male; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D012372:ROC Curve; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt