J Korean Med Sci.  2015 Oct;30(Suppl 1):S52-S58. 10.3346/jkms.2015.30.S1.S52.

Intraventricular Hemorrhage and Post Hemorrhagic Hydrocephalus among Very-Low-Birth-Weight Infants in Korea

• Ahn SY
• Shim SY
• Sung IK

• KMID: 2351136
• DOI: http://doi.org/10.3346/jkms.2015.30.S1.S52

Abstract

Here, we aimed to evaluate the incidence and mortality of intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) among very-low-birth-weight (VLBW) infants in Korea and assess the associated factors of PHH. This cohort study used prospectively collected data from the Korean Neonatal Network (KNN). Among 2,386 VLBW infants in the KNN database born between January 2013 and June 2014, 63 infants who died without brain ultrasonography results were excluded. Maternal demographics and neonatal clinical characteristics were assessed. The overall incidence of IVH in all the VLBW infants was 42.2% (987 of 2,323), while those of IVH grade 1, 2, 3, and 4 were 25.1%, 7.0%, 4.8%, and 5.5%, respectively. The incidence and severity of IVH showed a negatively correlating trend with gestational age and birth weight. PHH developed in 0%, 3.5%, 36.1%, and 63.8% of the surviving infants with IVH grades 1, 2, 3, and 4, respectively. Overall, in the VLBW infants, the IVH-associated mortality rate was 1.0% (24/2,323). Only IVH grade severity was proven to be an associated with PHH development in infants with IVH grades 3-4. This is the first Korean national report of IVH and PHH incidences in VLBW infants. Further risk factor analyses or quality improvement studies to reduce IVH are warranted.

Keyword

Infant, Newborn; Infant, Premature; Infant, Very-Low-Birth-Weight; Intracranial Hemorrhage; Hydrocephalus; Registries; Incidence; Epidemiology

MeSH Terms

Birth Weight
Cerebral Hemorrhage/*epidemiology/mortality/pathology
Cohort Studies
Databases, Factual
Echoencephalography
Female
Gestational Age
Humans
Hydrocephalus/*epidemiology/mortality/pathology
Incidence
Infant
Infant Mortality
Infant, Newborn
*Infant, Very Low Birth Weight
Male
Odds Ratio
Republic of Korea/epidemiology
Retrospective Studies
Severity of Illness Index

Figure

• 

  Fig. 1 Incidence of intraventricular hemorrhage (IVH) according to gestational age (GA) (A) and birth weight (BW) (B). The proportions of infants with grades 1, 2, 3, and 4 IVH and without IVH are presented according to GA and BW.

• 

  Fig. 2 Survival period of infants who expired primarily of intraventricular hemorrhage (IVH). The time of death is shown in terms of postnatal age (day). The median and interquartile range (25%-75%) are indicated.

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  Fig. 3 Cross-national comparisons of intraventricular hemorrhage incidences. Incidences of grade 2-4 (A) or grade 3-4 IVH (B) in the KNN were compared with those of the ANZNN, CNN, NICHD, and EuroNeoNet registries. IVH, intraventricular hemorrhage; KNN, Korean Neonatal Network; ANZNN, Australian and New Zealand Neonatal Network; CNN, Canadian Neonatal Network; NICHD, Eunice Kennedy Shriver National Institute of Child Health and Human Development; EuroNeoNet, European Neonatal Network; GW, gestational weeks.

Reference

1. Bassan H. Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol. 2009; 36:737–762. v

2. Murphy BP, Inder TE, Rooks V, Taylor GA, Anderson NJ, Mogridge N, Horwood LJ, Volpe JJ. Posthaemorrhagic ventricular dilatation in the premature infant: natural history and predictors of outcome. Arch Dis Child Fetal Neonatal Ed. 2002; 87:F37–F41.

3. McCrea HJ, Ment LR. The diagnosis, management, and postnatal prevention of intraventricular hemorrhage in the preterm neonate. Clin Perinatol. 2008; 35:777–792. vii

4. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, Hale EC, Newman NS, Schibler K, Carlo WA, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010; 126:443–456.

5. Radic JA, Vincer M, McNeely PD. Temporal trends of intraventricular hemorrhage of prematurity in Nova Scotia from 1993 to 2012. J Neurosurg Pediatr. 2015; 15:573–579.

6. Batton DG, DeWitte DB, Boal DK, Nardis EE, Maisels MJ. Incidence and severity of intraventricular hemorrhage: 1981-1984. Am J Perinatol. 1986; 3:353–356.

7. Philip AG, Allan WC, Tito AM, Wheeler LR. Intraventricular hemorrhage in preterm infants: declining incidence in the 1980s. Pediatrics. 1989; 84:797–801.

8. Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr. 2012; 9:242–258.

9. Vergani P, Patanè L, Doria P, Borroni C, Cappellini A, Pezzullo JC, Ghidini A. Risk factors for neonatal intraventricular haemorrhage in spontaneous prematurity at 32 weeks gestation or less. Placenta. 2000; 21:402–407.

10. Kennedy CR, Ayers S, Campbell MJ, Elbourne D, Hope P, Johnson A. Randomized, controlled trial of acetazolamide and furosemide in posthemorrhagic ventricular dilation in infancy: follow-up at 1 year. Pediatrics. 2001; 108:597–607.

11. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978; 92:529–534.

12. Brouwer MJ, de Vries LS, Pistorius L, Rademaker KJ, Groenendaal F, Benders MJ. Ultrasound measurements of the lateral ventricles in neonates: why, how and when? A systematic review. Acta Paediatr. 2010; 99:1298–1306.

13. Whitelaw A, Aquilina K. Management of posthaemorrhagic ventricular dilatation. Arch Dis Child Fetal Neonatal Ed. 2012; 97:F229–F233.

14. Behjati S, Emami-Naeini P, Nejat F, El Khashab M. Incidence of hydrocephalus and the need to ventriculoperitoneal shunting in premature infants with intraventricular hemorrhage: risk factors and outcome. Childs Nerv Syst. 2011; 27:985–989.

15. Kazan S, Güra A, Uçar T, Korkmaz E, Ongun H, Akyuz M. Hydrocephalus after intraventricular hemorrhage in preterm and low-birth weight infants: analysis of associated risk factors for ventriculoperitoneal shunting. Surg Neurol. 2005; 64:S77–S81.

16. Adams-Chapman I, Hansen NI, Stoll BJ, Higgins R. Nichd Research Network. Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion. Pediatrics. 2008; 121:e1167–e1177.

17. Chang YS, Ahn SY, Park WS. The Establishment of the Korean Neonatal Network (KNN). Neonatal Med. 2013; 20:169–178.

18. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001; 163:1723–1729.

19. Canadian Neonatal Network. CNN 2013 Annual Report. accessed on 1 April 2015. Available at http://www.canadianneonatalnetwork.org/portal/.

20. Australian & New Zealand Neonatal Network. Report of the Australian and New Zealand Neonatal Network 2012. accessed on 1 April 2015. Available at https://npesu.unsw.edu.au/data-collection/australian-new-zealand-neonatal-network-anznn.

21. EuroNeoNet. EuroNeoNet Annual Report for VLGAI and Individual Report for Each Unit Practicipating in the EuroNeoNet Project, YEAR 2011. accessed on 1 April 2015. Available at http://www.euroneonet.eu/Paginas/Publicas/euroNeo/euroNeoNet/ennet_documents.htm.

22. Singh R, Gorstein SV, Bednarek F, Chou JH, McGowan EC, Visintainer PF. A predictive model for SIVH risk in preterm infants and targeted indomethacin therapy for prevention. Sci Rep. 2013; 3:2539.

23. Hallevi H, Walker KC, Kasam M, Bornstein N, Grotta JC, Savitz SI. Inflammatory response to intraventricular hemorrhage: time course, magnitude and effect of t-PA. J Neurol Sci. 2012; 315:93–95.

24. Del Bigio MR. Pathophysiologic consequences of hydrocephalus. Neurosurg Clin N Am. 2001; 12:639–649. vii

25. Whitelaw A, Thoresen M, Pople I. Posthaemorrhagic ventricular dilatation. Arch Dis Child Fetal Neonatal Ed. 2002; 86:F72–F74.

26. Strahle J, Garton HJ, Maher CO, Muraszko KM, Keep RF, Xi G. Mechanisms of hydrocephalus after neonatal and adult intraventricular hemorrhage. Transl Stroke Res. 2012; 3:25–38.

27. Ahn SY, Chang YS, Sung DK, Sung SI, Yoo HS, Lee JH, Oh WI, Park WS. Mesenchymal stem cells prevent hydrocephalus after severe intraventricular hemorrhage. Stroke. 2013; 44:497–504.

28. Larroche JC. Post-haemorrhagic hydrocephalus in infancy. Anatomical study. Biol Neonate. 1972; 20:287–299.

29. Hudgins RJ, Boydston WR, Hudgins PA, Morris R, Adler SM, Gilreath CL. Intrathecal urokinase as a treatment for intraventricular hemorrhage in the preterm infant. Pediatr Neurosurg. 1997; 26:281–287.

30. Boillat CA, Jones HC, Kaiser GL, Harris NG. Ultrastructural changes in the deep cortical pyramidal cells of infant rats with inherited hydrocephalus and the effect of shunt treatment. Exp Neurol. 1997; 147:377–388.

31. Wright LC, McAllister JP 2nd, Katz SD, Miller DW, Lovely TJ, Salotto AG, Wolfson BJ. Cytological and cytoarchitectural changes in the feline cerebral cortex during experimental infantile hydrocephalus. Pediatr Neurosurg. 1990; 16:139–155.

32. Limbrick DD Jr, Mathur A, Johnston JM, Munro R, Sagar J, Inder T, Park TS, Leonard JL, Smyth MD. Neurosurgical treatment of progressive posthemorrhagic ventricular dilation in preterm infants: a 10-year single-institution study. J Neurosurg Pediatr. 2010; 6:224–230.

33. de Vries LS, Liem KD, van Dijk K, Smit BJ, Sie L, Rademaker KJ, Gavilanes AW. Dutch Working Group of Neonatal Neurology. Early versus late treatment of posthaemorrhagic ventricular dilatation: results of a retrospective study from five neonatal intensive care units in The Netherlands. Acta Paediatr. 2002; 91:212–217.

34. Lin JP, Goh W, Brown JK, Steers AJ. Neurological outcome following neonatal post-haemorrhagic hydrocephalus: the effects of maximum raised intracranial pressure and ventriculo-peritoneal shunting. Childs Nerv Syst. 1992; 8:190–197.

35. Bruinsma N, Stobberingh EE, Herpers MJ, Vles JS, Weber BJ, Gavilanes DA. Subcutaneous ventricular catheter reservoir and ventriculoperitoneal drain-related infections in preterm infants and young children. Clin Microbiol Infect. 2000; 6:202–206.

36. Johnson A, Wincott E, Grant A, Elbourne D. Randomised trial of early tapping in neonatal posthaemorrhagic ventricular dilatation: results at 30 months. Arch Dis Child. 1994; 71:F147.

37. Anwar M, Kadam S, Hiatt IM, Hegyi T. Serial lumbar punctures in prevention of post-hemorrhagic hydrocephalus in preterm infants. J Pediatr. 1985; 107:446–450.

38. Bolisetty S, Dhawan A, Abdel-Latif M, Bajuk B, Stack J, Lui K. New South Wales and Australian Capital Territory Intensive Care Units' Data Collection. Intraventricular hemorrhage and neurodevelopmental outcomes in extreme preterm infants. Pediatrics. 2014; 133:55–62.