Outcome for preterm infants with germinal matrix hemorrhage and progressive hydrocephalus

Neurosurgery. 1997 Nov;41(5):1111-7; discussion 1117-8. doi: 10.1097/00006123-199711000-00015.


Objective: An analysis of 76 preterm infants with Grade III or IV intracranial hemorrhage and surgically treated progressive hydrocephalus was undertaken to determine mortality, intellectual impairment, and motor deficit.

Methods: The variables examined were degree of prematurity, birth weight, sex, Apgar scores, extent of intracranial hemorrhage, seizures, age at time of initial placement of a ventricular catheter reservoir to control hydrocephalus, need to convert the reservoir to a ventriculoperitoneal shunt, timing of the conversion of the reservoir to a ventriculoperitoneal shunt, and number of shunt revisions. Outcome was assessed for statistical significance using hierarchical linear regression and logistic regression analyses.

Results: Linear regression analysis determined that mortality was best predicted, in order of importance, by extent of intracranial hemorrhage, number of shunt revisions, and birth weight (P < 0.0001, R = 0.79). Grade of hemorrhage, weight at birth, and presence of seizure activity were the most important determinants of motor outcome (P < 0.001, R = -0.78).

Conclusions: Logistic regression analysis of the 41 long-term survivors determined that grade of hemorrhage was the most important variable in determining cognitive outcome (P < 0.0001), motor function (P < 0.0001), and presence of seizure activity (P < 0.001). A logistic model of survival determined that grade of hemorrhage and multiple shunt revisions (more than five) were the most important determinants (P < 0.0001) of survival. In conclusion, the overwhelming factor in determining outcome in this patient group was the extent of intracranial hemorrhage.

MeSH terms

  • Apgar Score
  • Birth Weight
  • Cerebral Hemorrhage / physiopathology*
  • Cerebral Hemorrhage / psychology
  • Cerebral Hemorrhage / surgery*
  • Female
  • Follow-Up Studies
  • Gestational Age
  • Humans
  • Hydrocephalus / physiopathology*
  • Hydrocephalus / psychology
  • Hydrocephalus / surgery*
  • Infant, Newborn
  • Infant, Premature*
  • Male
  • Motor Activity
  • Prognosis
  • Regression Analysis
  • Seizures / epidemiology
  • Survival Rate
  • Time Factors
  • Ventriculoperitoneal Shunt