For preterm newborns with hydrocephalus, decompression of ventricles using a temporary device is frequently the first neurosurgical surgery. After observing a subgroup of infants who had intraparenchymal hemorrhage (IPH) following serial ventricular reservoir taps, the authors attempted to characterize IPH and its relationship to neurodevelopmental outcome. In this multicenter case-control research, a gestational age-matched control with reservoir who did not develop IPH was chosen for each neonate with periventricular and subcortical IPH. The researchers looked at digital cerebral ultrasound (cUS) scans and term-equivalent age (TEA)–MRI (TEA-MRI) studies. Researchers took Ventricular measures before, 3 days after, and 7 days after the reservoir insertion. They calculated volume changes in the ventricles. They used Standardized assessments to examine neurodevelopmental outcomes at 2 years corrected age.
The study comprised 18 neonates with IPH (mean gestational age 30.0 ± 4.3 weeks) and 18 matched controls. Infants with IPH had a higher ventricular volume reduction than occipitofrontal head circumference following 7 days of reservoir taps (mean difference -0.19 [95% CI -0.37 to -0.004], p = 0.04). Infants with and without IPH had similar cognitive and motor Z-scores (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). After controlling for age at the time of assessment, multifocal IPH was adversely linked 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). The purpose of this study was the first to show that IPH can emerge in neonates with hydrocephalus after a rapid decline in ventricular capacity within the first week after serial reservoir taps are started. More research into using cUS to guide the amount of cerebrospinal fluid removed is needed.