J Korean Neurosurg Soc.  2023 May;66(3):247-257. 10.3340/jkns.2023.0052.

Clinical Feature and General Management of Post-Hemorrhagic Hydrocephalus in Premature Infants

• Ichi S

• KMID: 2542009
• DOI: http://doi.org/10.3340/jkns.2023.0052

Abstract

Recently, the survival of the high-risk population of preterm infants has steadily improved, and the severity of prematurity is a growing threat of gestational-age-related fatal conditions. Posthemorrhagic hydrocephalus (PHH) is the most common but serious neurological complication in premature infants, which can have life-threatening consequences during the acute phase in the neonatal period and life-long psychomotor and cognitive sequelae in their later life. Although neonatologists, pediatric neurologists, and pediatric neurosurgeons have investigated a diversified strategy for several decades, a consensus on the best management of PHH in premature infants still must be reached. Several approaches have tried to reduce the incidence of intraventricular hemorrhage (IVH) and mitigate the effect of IVH-related hydrocephalus. This paper reviews and discusses the clinical feature of PHH in premature infants, general/nonsurgical management of prematurity for IVH prevention, and posthemorrhagic management, and how and when to intervene.

Keyword

Hydrocephalus; Premature infants; Medical practice management

Figure

• 

  Fig. 1. Stress-velocity relationship (mVcfc-ESWS) cited from the figure provided by Toyoshima et al. [75] with permission from Elsevier. Significant correlations were found between ESWS and mVcfc in both groups (mVcfc = 3.76 × ESWS-0.4; p<0.01, R=0.56). Group 1 : infants with complications (pulmonary hemorrhage, intraventricular hemorrhage, and periventricular leukomalacia; n=9). Group 2 : infants without complications (n=24). Systolic blood pressure and mean blood pressure changed over time, with no differences between the groups. mVcfc : mean velocity of circumferential fiber shortening, ESWS : end-systolic wall stress.

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  Fig. 2. Classification of the perfusion waveforms of the internal cerebral vein on ultrasonography into four patterns cited from the figure provided by Ikeda et al. [32] with permission from John Wiley and Sons : (A) grade 0 (low grade), steady flow waveform with a constant perfusion speed; (B) grade 1 (low grade), the waveform fluctuates, but the minimum speed is never less than half the maximum speed; (C) grade 2 (high grade), the waveform fluctuates, and although the minimum speed is less than half the maximum speed, it never drop to 0 cm/s; (D) grade 3 (high grade), the waveform fluctuates, with the speed sometimes dropping to 0 cm/s.

Reference

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