Document Detail


Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts.
MedLine Citation:
PMID:  22380952     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Preterm infants are at risk for perinatal complications, including germinal matrix-intraventricular hemorrhage (IVH) and subsequent posthemorrhagic hydrocephalus (PHH). This review summarizes the current understanding of the epidemiology, pathophysiology, management, and outcomes of IVH and PHH in preterm infants.
METHODS: The MEDLINE database was systematically searched using terms related to IVH, PHH, and relevant neurosurgical procedures to identify publications in the English medical literature. To complement information from the systematic search, pertinent articles were selected from the references of articles identified in the initial search.
RESULTS: This review summarizes the current knowledge regarding the epidemiology and pathophysiology of IVH and PHH, primarily using evidence-based studies. Advances in obstetrics and neonatology over the past few decades have contributed to a marked improvement in the survival of preterm infants, and neurological morbidity is also starting to decrease. The incidence of IVH is declining, and the incidence of PHH will likely follow. Currently, approximately 15% of preterm infants who suffer severe IVH will require permanent CSF diversion. The clinical presentation and surgical management of symptomatic PHH with temporary ventricular reservoirs (ventricular access devices) and ventriculosubgaleal shunts and permanent ventriculoperitoneal shunts are discussed. Preterm infants who develop PHH that requires surgical treatment remain at high risk for other related neurological problems, including cerebral palsy, epilepsy, and cognitive and behavioral delay. This review highlights numerous opportunities for further study to improve the care of these children.
CONCLUSIONS: A better grasp of the pathophysiology of IVH is beginning to impact the incidence of IVH and PHH. Neonatologists conduct rigorous Class I and II studies to advance the outcomes of preterm infants. The need for well-designed multicenter trials is essential because of the declining incidence of IVH and PHH, variations in referral patterns, and neonatal ICU and neurosurgical management. Well-designed multicenter trials will eventually produce evidence to enable neurosurgeons to provide their smallest, most vulnerable patients with the best practices to minimize perioperative complications and permanent shunt dependence, and most importantly, optimize long-term neurodevelopmental outcomes.
Authors:
Shenandoah Robinson
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  9     ISSN:  1933-0715     ISO Abbreviation:  J Neurosurg Pediatr     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-02     Completed Date:  2012-05-22     Revised Date:  2013-12-08    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  242-58     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Cerebral Hemorrhage / epidemiology,  physiopathology*,  therapy*
Cerebral Ventricles
Humans
Hydrocephalus / epidemiology,  physiopathology*,  therapy*
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / epidemiology,  physiopathology*,  therapy*
Grant Support
ID/Acronym/Agency:
R01 NS060765/NS/NINDS NIH HHS; R01NS060765/NS/NINDS NIH HHS
Comments/Corrections
Comment In:
J Neurosurg Pediatr. 2012 Mar;9(3):239-40; discussion 240-1   [PMID:  22380951 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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