Liu Yi,Qin Qi,Zhang Jia,et al.Analysis of risk factors of hydrocephalus after intraventricular hemorrhage in infants[J].Journal of Clinical Pediatric Surgery,,():242-246.[doi:10.3760/cma.j.cn101785-202208008-008]
Analysis of risk factors of hydrocephalus after intraventricular hemorrhage in infants
- Keywords:
- Infants; Hydrocephalus; Intraventricular Hemorrhage; Risk Factors; Surgical Procedures; Operative
- Abstract:
- Objective To explore the related risk factors of posthemorrhagic hydrocephalus (PHH) after intraventricular hemorrhage (IVH) in infants.Methods From June 2013 to January 2022,retrospective analysis was conducted for clinical data of 112 hospitalized children.Exploring the related factors of PHH by following up on whether the patient has developed hydrocephalus after IVH.They were assigned into two groups of PHH (n=55) and resolved ventricular dilation (RVD,n=57).Univariate and multivariate Logistic regressions were utilized for examining the risk factors of hydrocephalus after IVH.Results And 55 cases (55/112,49%) developed PHH.58 cases (51.79%) received simple conservative symptomatic treatment; 28 cases (25%) underwent lumbar puncture.Twenty-six patients (23.21%) received VPS treatment.The incidence of PHH was 49% (55/112).Among 112 children,5(4.46%) died from pulmonary insufficiency (n=2) and multiple organ failure (n=3).Among 107 survivors,there were epilepsy (n=3,2.80%),visual impairment (n=1,0.93%),hearing impairment (n=6,5.61%) had and cerebral palsy (n=5,4.67%) during follow-ups.The results of multivariate Logistic regression analysis showed;Gestational age at birth was 28 to 32 weeks(OR=19.078,95%CI:2.408-151.140,P=0.005) and prenatal steroids were not used(OR=20.642,95%CI:1.882-226.404,P=0.013) and high ventricular hemorrhage(OR=94.193,95%CI:16.583-535.043,P<0.001) were independent risk factor for PHH.Conclusions Low gestational age,prenatal steroids were not used,and high ventricular hemorrhage are all associated with PHH in infants and young children with IVH.During the perioperative period,attention should be paid to the gestational age,weight,prenatal steroid use,and level of intraventricular hemorrhage in IVH patients,and timely intervention should be taken to prevent their development into PHH and improve their prognosis.
References:
[1] Christian EA,Jin DL,Attenello F,et al.Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States,2000-2010[J].J Neurosurg Pediatr,2016,17(3):260-269.DOI:10.3171/2015.7.PEDS15140.
[2] Behrens P,Tietze A,Walch E,et al.Neurodevelopmental outcome at 2 years after neuroendoscopic lavage in neonates with posthemorrhagic hydrocephalus[J].J Neurosurg Pediatr,2020,26(5):495-503.DOI:10.3171/2020.5.PEDS20211.
[3] Klinger G,Osovsky M,Boyko V,et al.Risk factors associated with post-hemorrhagic hydrocephalus among very low birth weight infants of 24-28 weeks gestation[J].J Perinatol,2016,36(7):557-563.DOI:10.1038/jp.2016.18.
[4] Egesa WI,Odoch S,Odong RJ,et al.Germinal matrix-intraventricular hemorrhage:a tale of preterm infants[J].Int J Pediatr,2021,2021:6622598.DOI:10.1155/2021/6622598.
[5] Papile LA,Burstein J,Burstein R,et al.Incidence and evolution of subependymal and intraventricular hemorrhage:a study of infants with birth weights less than 1,500 gm[J].J Pediatr,1978,92(4):529-534.DOI:10.1016/s0022-3476(78)80282-0.
[6] Fischer AQ,Livingstone JN2nd.Transcranial Doppler and real-time cranial sonography in neonatal hydrocephalus[J].J Child Neurol,1989,4(1):64-69.DOI:10.1177/088307388900400112.
[7] 吴娜,谢乂民,陈思远,等.外科治疗自发性脑室出血患儿的疗效分析[J].临床小儿外科杂志,2019,18(6):518-522.DOI:10.3969/j.issn.1671-6353.2019.06.016.Wu N,Xie YM,Chen SY,et al.Surgical efficacy of spontaneous intraventricular hemorrhage in infants and toddlers[J].J Clin Ped Sur,2019,18(6):518-522.DOI:10.3969/j.issn.1671-6353.2019.06.016.
[8] Robinson S,Jantzie LL.Pathogenesis of posthemorrhagic hydrocephalus of prematurity:new horizons[J].Semin Perinatol,2022,46(5):151596.DOI:10.1016/j.semperi.2022.151596.
[9] Lu HY,Wang QX,Lu JY,et al.Risk factors for intraventricular hemorrhage in preterm infants born at 34 weeks of gestation or less following preterm premature rupture of membranes[J].J Stroke Cerebrovasc Dis,2016,25(4):807-812.DOI:10.1016/j.jstrokecerebrovasdis.2015.12.011.
[10] Dalton J,Dechert RE,Sarkar S.Assessment of association between rapid fluctuations in serum sodium and intraventricular hemorrhage in hypernatremic preterm infants[J].Am J Perinatol,2015,32(8):795-802.DOI:10.1055/s-0034-1396691.
[11] ?zek E,Kersin SG.Intraventricular hemorrhage in preterm babies[J].Turk Pediatri Ars,2020,55(3):215-221.DOI:10.14744/TurkPediatriArs.2020.66742.
[12] Brouwer AJ,Groenendaal F,Benders MJ,et al.Early and late complications of germinal matrix-intraventricular haemorrhage in the preterm infant:what is new?[J].Neonatology,2014,106(4):296-303.DOI:10.1159/000365127.
[13] Enzmann D,Murphy-Irwin K,Stevenson D,et al.The natural history of subependymal germinal matrix hemorrhage[J].Am J Perinatol,1985,2(2):123-133.DOI:10.1055/s-2007-999929.
[14] Shankaran S,Bajaj M,Natarajan G,et al.Outcomes following post-hemorrhagic ventricular dilatation among infants of extremely low gestational age[J].J Pediatr,2020,226:36-44.e3.DOI:10.1016/j.jpeds.2020.07.080.
[15] Flores G,Amaral-Nieves N,De Jesús O,et al.Risk factors for developing hydrocephalus in neonatal intraventricular hemorrhage[J].P R Health Sci J,2020,39(1):55-57.
[16] Travers CP,Hansen NI,Das A,et al.Potential missed opportunities for antenatal corticosteroid exposure and outcomes among periviable births:observational cohort study[J].BJOG,2022,129(12):2039-2051.DOI:10.1111/1471-0528.17230.
[17] Ment LR,Oh W,Ehrenkranz RA,et al.Antenatal steroids,delivery mode and intraventricular hemorrhage in preterm infants[J].Am J Obstet Gynecol,1995,172(3):795-800.DOI:10.1016/0002-9378(95)90001-2.
[18] Stoll BJ,Hansen NI,Bell EF,et al.Trends in care practices,morbidity,and mortality of extremely preterm neonates,1993-2012[J].JAMA,2015,314(10):1039-1051.DOI:10.1001/jama.2015.10244.
[19] Roberts D,Brown J,Medley N,et al.Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth[J].Cochrane Database Syst Rev,2017,3(3):CD004454.DOI:10.1002/14651858.CD004454.pub3.
[20] Lim WH,Lien R,Chiang MC,et al.Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants[J].J Perinatol,2011,31(3):193-198.DOI:10.1038/jp.2010.86.
[21] Tang YW,Ma CX,Cui W,et al.The risk of birth defects in multiple births:a population-based study[J].Matern Child Health J,2006,10(1):75-81.DOI:10.1007/s10995-005-0031-5.
[22] Munch TN,Rostgaard K,Rasmussen MLH,et al.Familial aggregation of congenital hydrocephalus in a nationwide cohort[J].Brain,2012,135(Pt 8):2409-2415.DOI:10.1093/brain/aws158.
Memo
收稿日期:2022-8-4。
基金项目:深圳市医学研究专项基金(2302038)
通讯作者:董辉,Email:dh19710305@163.com