title: Anatomical configurations associated with posthemorrhagic hydrocephalus among premature infants with intraventricular hemorrhage.
abstract: OBJECTIVE Intraventricular hemorrhage (IVH) is a complication of prematurity often associated with ventricular dilation, which may resolve over time or progress to posthemorrhagic hydrocephalus (PHH). This study investigated anatomical factors that could predispose infants with IVH to PHH. METHODS The authors analyzed a cohort of premature infants diagnosed with Grade III or IV IVH between 2004 and 2014. Using existing ultrasound and MR images, the CSF obstruction pattern, skull shape, and brain/skull ratios were determined, comparing children with PHH to those with resolved ventricular dilation (RVD), and comparing both groups to a set of healthy controls. RESULTS Among 110 premature infants with Grade III or IV IVH, 65 (59%) developed PHH. Infants with PHH had more severe ventricular dilation compared with those with RVD, although ranges overlapped. Intraventricular CSF obstruction was observed in 36 (86%) of 42 infants with PHH and 0 (0%) of 18 with RVD (p < 0.001). The distribution of skull shapes in infants with PHH was similar to those with RVD, although markedly different from controls. No significant differences in supratentorial brain/skull ratio were observed; however, the mean infratentorial brain/skull ratio of infants with PHH was 5% greater (more crowded) than controls (p = 0.006), whereas the mean infratentorial brain/skull ratio of infants with RVD was 8% smaller (less crowded) than controls (p = 0.004). CONCLUSIONS Among premature infants with IVH, intraventricular obstruction and infratentorial crowding are strongly associated with PHH, further underscoring the need for brain MRI in surgical planning. Prospective studies are required to determine which factors are cause and which are consequence, and which can be used to predict the need for surgical intervention.
authors: Departments of 1 Neurology.|Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington.
authors: Hannah M
authors: HM
authors: Tully
authors: Pediatrics, and.
authors: Tara L
authors: TL
authors: Wenger
authors: Epidemiology, University of Washington; and.
authors: Walter A
authors: WA
authors: Kukull
authors: Pediatrics, and.|Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington.
authors: Dan
authors: D
authors: Doherty
authors: Departments of 1 Neurology.|Pediatrics, and.|Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington.
authors: William B
authors: WB
authors: Dobyns
mesh_terms: D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D002552:Cerebral Ventricles / Q000033:anatomy & histology* / Q000000981:diagnostic imaging* / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: CPC = choroid plexus cauterization; ETV = endoscopic third ventriculostomy; IVH = intraventricular hemorrhage; PHH = posthemorrhagic hydrocephalus; RVD = resolved ventricular dilation; intraventricular hemorrhage; posthemorrhagic hydrocephalus; prematurity