Randomized Controlled Early versus Late Ventricular Intervention Study in Posthemorrhagic Ventricular Dilatation: Outcome at 2 Years

J Pediatr. 2020 Nov:226:28-35.e3. doi: 10.1016/j.jpeds.2020.08.014. Epub 2020 Aug 12.


Objective: To compare the effect of intervention at low vs high threshold of ventriculomegaly in preterm infants with posthemorrhagic ventricular dilatation on death or severe neurodevelopmental disability.

Study design: This multicenter randomized controlled trial reviewed lumbar punctures initiated after either a low threshold (ventricular index of >p97 and anterior horn width of >6 mm) or high threshold (ventricular index of >p97 + 4 mm and anterior horn width of >10 mm). The composite adverse outcome was defined as death or cerebral palsy or Bayley composite cognitive/motor scores <-2 SDs at 24 months corrected age.

Results: Outcomes were assessed in 113 of 126 infants. The composite adverse outcome was seen in 20 of 58 infants (35%) in the low threshold group and 28 of 55 (51%) in the high threshold (P = .07). The low threshold intervention was associated with a decreased risk of an adverse outcome after correcting for gestational age, severity of intraventricular hemorrhage, and cerebellar hemorrhage (aOR, 0.24; 95% CI, 0.07-0.87; P = .03). Infants with a favorable outcome had a smaller fronto-occipital horn ratio (crude mean difference, -0.06; 95% CI, -0.09 to -0.03; P < .001) at term-equivalent age. Infants in the low threshold group with a ventriculoperitoneal shunt, had cognitive and motor scores similar to those without (P = .3 for both), whereas in the high threshold group those with a ventriculoperitoneal shunt had significantly lower scores than those without a ventriculoperitoneal shunt (P = .01 and P = .004, respectively).

Conclusions: In a post hoc analysis, earlier intervention was associated with a lower odds of death or severe neurodevelopmental disability in preterm infants with progressive posthemorrhagic ventricular dilatation.

Trial registration: ISRCTN43171322.

Keywords: Hydrocephalus; neurodevelopmental outcome; posthemorrhagic ventricular dilatation; preterm.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Cerebral Hemorrhage / complications*
  • Cerebral Hemorrhage / psychology
  • Cerebral Hemorrhage / surgery*
  • Cerebral Ventricles / pathology*
  • Child, Preschool
  • Cohort Studies
  • Dilatation, Pathologic
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / psychology
  • Infant, Premature, Diseases / surgery*
  • Male
  • Neurodevelopmental Disorders / diagnosis
  • Neurodevelopmental Disorders / epidemiology*
  • Neurodevelopmental Disorders / prevention & control
  • Spinal Puncture
  • Time-to-Treatment*
  • Ventriculoperitoneal Shunt