J Korean Med Sci.  2024 Apr;39(15):e139. 10.3346/jkms.2024.39.e139.

Current Status and Associated Factors of Post-Hemorrhagic Hydrocephalus in Infants of 22 to 28 Weeks Gestation With Severe Intraventricular Hemorrhage in Korea: A Nationwide Cohort Study

• Yang M
• Kim S
• Sung SI
• Chang YS
• Park WS
• Ahn SY

• KMID: 2555471
• DOI: http://doi.org/10.3346/jkms.2024.39.e139

Abstract

Background
Post-hemorrhagic hydrocephalus (PHH), a common complication of severe intraventricular hemorrhage (IVH) in very low birth weight (BW) infants, is associated with significant morbidity and poor neurological outcomes. The objective of this study was to assess the current status of PHH and analyze the risk factors associated with the necessity of treatment for PHH in infants born between 22 and 28 weeks of gestation, specifically those with severe IVH (grade 3 or 4).
Methods
The analysis was conducted on 1,097 infants who were born between 22–28 gestational weeks and diagnosed with severe IVH, using data from the Korean Neonatal Network. We observed that the prevalence of PHH requiring treatment was 46.3% in infants with severe IVH.
Results
Higher rates of mortality, transfer during admission, cerebral palsy, and ventriculoperitoneal shunt after discharge were higher in infants with PHH than in those without PHH. PHH in severe IVH was associated with a higher rate of pulmonary hemorrhage, seizures, and IVH grade 4 in the entire cohort. In addition, it was associated with a lower rate of small for gestational age and chorioamnionitis. In the subgroup analysis, high BW, outborn status, pulmonary hemorrhage, seizure, sepsis, and IVH grade 4 were associated with a higher incidence of PHH between 22 and 25 gestational weeks (GW). In infants born between 26 and 28 GW, a higher incidence of PHH was associated with seizures and IVH grade 4.
Conclusion
It is necessary to maintain meticulous monitoring and neurological intervention for infants with PHH not only during admission but also after discharge. In addition, identifying the clinical factors that increase the likelihood of developing PHH from severe IVH is crucial.

Keyword

Posthemorrhagic Hydrocephalus; Intraventricular Hemorrhage; Preterm Infants

Figure

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  Fig. 1 Study population.VLBW = very low birth weight, KNN = Korean Neonatal Network, IVH = intraventricular hemorrhage, BUS = brain ultrasonography, PHH = post-hemorrhagic hydrocephalus.

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  Fig. 2 Epidemiology of PHH. (A) Incidence of post-hemorrhagic hydrocephalus. (B) Mortality according to post-hemorrhagic hydrocephalus. (C) Transfer rate for neurosurgery according to post-hemorrhagic hydrocephalus.PHH = post-hemorrhagic hydrocephalus.*P < 0.05.

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