TY - JOUR
T1 - Intraparenchymal hemorrhage after serial ventricular reservoir taps in neonates with hydrocephalus and association with neurodevelopmental outcome at 2 years of age
AU - Cizmeci, Mehmet N.
AU - de Vries, Linda S.
AU - Tataranno, Maria Luisa
AU - Zecic, Alexandra
AU - van de Pol, Laura A.
AU - Alarcon, Ana
AU - Groenendaal, Floris
AU - Woerdeman, Peter A.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - OBJECTIVE Decompressing the ventricles with a temporary device is often the initial neurosurgical intervention for preterm infants with hydrocephalus. The authors observed a subgroup of infants who developed intraparenchymal hemorrhage (IPH) after serial ventricular reservoir taps and sought to describe the characteristics of IPH and its association with neurodevelopmental outcome. METHODS In this multicenter, case-control study, for each neonate with periventricular and/or subcortical IPH, a gestational age-matched control with reservoir who did not develop IPH was selected. Digital cranial ultrasound (cUS) scans and term-equivalent age (TEA)–MRI (TEA-MRI) studies were assessed. Ventricular measurements were recorded prior to and 3 days and 7 days after reservoir insertion. Changes in ventricular volumes were calculated. Neurodevelopmental outcome was assessed at 2 years corrected age using standardized tests. RESULTS Eighteen infants with IPH (mean gestational age 30.0 ± 4.3 weeks) and 18 matched controls were included. Reduction of the ventricular volumes relative to occipitofrontal head circumference after 7 days of reservoir taps was greater in infants with IPH (mean difference −0.19 [95% CI −0.37 to −0.004], p = 0.04). Cognitive and motor Z-scores were similar in infants with and those without IPH (mean difference 0.42 [95% CI −0.17 to 1.01] and 0.58 [95% CI −0.03 to 1.2]; p = 0.2 and 0.06, respectively). Multifocal IPH was negatively associated with cognitive score (coefficient −0.51 [95% CI −0.88 to −0.14], p = 0.009) and ventriculoperitoneal shunt with motor score (coefficient −0.50 [95% CI −1.6 to −0.14], p = 0.02) after adjusting for age at the time of assessment. CONCLUSIONS This study reports for the first time that IPH can occur after a rapid reduction of the ventricular volume during the 1st week after the initiation of serial reservoir taps in neonates with hydrocephalus. Further studies on the use of cUS to guide the amount of cerebrospinal fluid removal are warranted.
AB - OBJECTIVE Decompressing the ventricles with a temporary device is often the initial neurosurgical intervention for preterm infants with hydrocephalus. The authors observed a subgroup of infants who developed intraparenchymal hemorrhage (IPH) after serial ventricular reservoir taps and sought to describe the characteristics of IPH and its association with neurodevelopmental outcome. METHODS In this multicenter, case-control study, for each neonate with periventricular and/or subcortical IPH, a gestational age-matched control with reservoir who did not develop IPH was selected. Digital cranial ultrasound (cUS) scans and term-equivalent age (TEA)–MRI (TEA-MRI) studies were assessed. Ventricular measurements were recorded prior to and 3 days and 7 days after reservoir insertion. Changes in ventricular volumes were calculated. Neurodevelopmental outcome was assessed at 2 years corrected age using standardized tests. RESULTS Eighteen infants with IPH (mean gestational age 30.0 ± 4.3 weeks) and 18 matched controls were included. Reduction of the ventricular volumes relative to occipitofrontal head circumference after 7 days of reservoir taps was greater in infants with IPH (mean difference −0.19 [95% CI −0.37 to −0.004], p = 0.04). Cognitive and motor Z-scores were similar in infants with and those without IPH (mean difference 0.42 [95% CI −0.17 to 1.01] and 0.58 [95% CI −0.03 to 1.2]; p = 0.2 and 0.06, respectively). Multifocal IPH was negatively associated with cognitive score (coefficient −0.51 [95% CI −0.88 to −0.14], p = 0.009) and ventriculoperitoneal shunt with motor score (coefficient −0.50 [95% CI −1.6 to −0.14], p = 0.02) after adjusting for age at the time of assessment. CONCLUSIONS This study reports for the first time that IPH can occur after a rapid reduction of the ventricular volume during the 1st week after the initiation of serial reservoir taps in neonates with hydrocephalus. Further studies on the use of cUS to guide the amount of cerebrospinal fluid removal are warranted.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85126940130&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/34534961
U2 - https://doi.org/10.3171/2021.6.PEDS21120
DO - https://doi.org/10.3171/2021.6.PEDS21120
M3 - Article
C2 - 34534961
SN - 1933-0707
VL - 28
SP - 695
EP - 702
JO - Journal of Neurosurgery: Pediatrics
JF - Journal of Neurosurgery: Pediatrics
IS - 6
ER -