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Time-to-event analysis of surgically treated posthemorrhagic hydrocephalus in preterm infants: A single-institution retrospective study

Child's Nervous System Oct 20, 2017

Han RH, et al. - This study entailed the narration of the time points relevant to the neurosurgical management of posthemorrhagic hydrocephalus (PHH). The development of intraventricular hemorrhage (IVH) and ventriculomegaly took place within a few days of birth in a majority of the infants. Nevertheless, an observation was recommended of the at-risk infants for at least 4 weeks, with serial head ultrasounds to monitor for PHH requiring surgery.

Methods

  • 104 preterm infants with intraventricular hemorrhage (IVH) were enrolled for this study.
  • The participants received neurosurgical intervention for PHH at St. Louis Children's Hospital from 1994 to 2016.
  • Kaplan-Meier curves were designed for several endpoints.

Results

  • It was reported that the IVH grade on head ultrasound obtained through routine clinical care was II, III, and IV in 5 (4.8%), 33 (31.7%), and 66 (63.5%) of the patients, respectively.
  • Both IVH size and the location did not impart any effect on the development of PHH.
  • Days from birth to IVH, ventriculomegaly, temporizing neurosurgical procedure (TNP), and permanent neurosurgical intervention were 2.0 (95% CI 1.7-2.3), 3.0 (2.5-3.5), 24.0 (22.2-25.8), and 101.0 (90.4-111.6), respectively.
  • No variation was noted in the grades III and IV IVH in terms of age at the IVH diagnosis (Χ2 (1 d.f.) = 1.32, p = 0.25), ventriculomegaly (Χ2 = 0.73, p = 0.40), TNP (Χ2= 0.61, p = 0.43), or permanent intervention (Χ2= 2.48, p = 0.17).
  • Herein, the ventricular reservoirs and ventriculosubgaleal shunts were used in 71 (68.3%) and 30 (28.8%), respectively.
  • Eighty (76.9%) of the patients ultimately received a VPS.
  • Five (4.8%) underwent a primary endoscopic third ventriculostomy (ETV), and two (1.9%) had ETV for a revision procedure.
  • Four among the seven ETVs underwent choroid plexus cauterization.

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