title: Can neurophysiological assessment improve timing of intervention in posthaemorrhagic ventricular dilatation?
abstract: OBJECTIVE
  Intraventricular haemorrhage is still the most common cause of brain lesion in preterm infants and development of a posthaemorrhagic ventricular dilatation (PHVD) can lead to additional neurological sequelae. Flash visual evoked potentials (fVEP) and amplitude-integrated electroencephalography (aEEG) are non-invasive neurophysiological monitoring tools. The aim of the study was to evaluate fVEPs and aEEGs in preterm infants with progressive PHVD prior to and after neurosurgical intervention for cerebrospinal fluid removal and to correlate the findings with severity of ventricular dilatation.
  
  
  METHODS
  fVEPs and aEEGs were performed weekly in infants with developing PHVD. As soon as the ventricular index reached the 97th percentile recordings were performed twice a week.
  
  
  METHODS
  17 patients admitted to the neonatal intensive care unit of the Medical University of Vienna who developed progressive PHVD were evaluated using fVEP and aEEG until and after reduction of intracranial pressure by placement of an external ventricular drainage.
  
  
  RESULTS
  In all 17 cases (100%) wave latencies of fVEP increased above normal range and aEEG showed increased suppression in 13 patients (76%) with increasing ventricular dilatation. Both methods showed normalisation of patterns mostly within a week of successful therapeutic intervention (mean 8.5 days). Both changes in fVEP latencies and aEEG background patterns were detected before clinical signs of elevated intracranial pressure occurred. In only 10 patients (58.8%) ventricular width exceeded the 97th percentile+4 mm.
  
  
  CONCLUSIONS
  fVEP and aEEG are useful additional tools for the evaluation of preterm infants with progressive PHVD.
authors.affiliation: Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria. katrin.klebermass-schrehof@meduniwien.ac.at
authors.forename: Katrin
authors.initials: K
authors.lastname: Klebermass-Schrehof
authors.forename: Zsofia
authors.initials: Z
authors.lastname: Rona
authors.forename: Thomas
authors.initials: T
authors.lastname: Waldhör
authors.forename: Christine
authors.initials: C
authors.lastname: Czaba
authors.forename: Anna
authors.initials: A
authors.lastname: Beke
authors.forename: Manfred
authors.initials: M
authors.lastname: Weninger
authors.forename: Monika
authors.initials: M
authors.lastname: Olischar
mesh_terms: D001317:Austria; D002543:Cerebral Hemorrhage / Q000175:diagnosis*; D002552:Cerebral Ventricles / Q000473:pathology*; D004108:Dilatation, Pathologic / Q000175:diagnosis*; D004569:Electroencephalography; D005074:Evoked Potentials, Visual / Q000502:physiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis*; D007363:Intensive Care Units, Neonatal; D019586:Intracranial Hypertension / Q000175:diagnosis; D007427:Intracranial Pressure; D012720:Severity of Illness Index; D013997:Time Factors