Timing of external ventricular drainage and neurodevelopmental outcome in preterm infants with posthemorrhagic hydrocephalus

Eur J Paediatr Neurol. 2012 Nov;16(6):662-70. doi: 10.1016/j.ejpn.2012.04.002. Epub 2012 May 15.

Abstract

Objective: To delineate the impact of early (≤ 25 days of life) versus late (> 25 days) external ventricular drainage (EVD) on the neurodevelopmental outcome of preterm infants with posthemorrhagic hydrocephalus (PHH) following intraventricular hemorrhage (IVH).

Methods: We retrospectively categorized 32 premature infants with PHH into two groups according to whether they underwent early (n = 10) or late (n = 22) EVD. We administered the Battelle Developmental Inventory II and a neuromotor examination (median age, 73 months, range: 29-100).

Results: In adjusted comparisons, early EVD was associated with better scores than late EVD in adaptive (79 ± 22.6 vs. 58.8 ± 8.1, P = .01), personal social (90.7 ± 26 vs. 67.3 ± 15.9, P = .02), communication (95.4 ± 27.5 vs. 69.6 ± 20.5, P = .04) and cognitive (78.9 ± 24.4 vs. 60.7 ± 11.5, P = .055) functions. Three (30%) early EVD infants had severe (<2.5 standard deviation) cognitive disability compared to 18 (82%) late EVD infants (P = .03). The incidences of cerebral palsy and neurosurgical complications were equal for the two groups. Subgroup analyses suggested that early EVD was beneficial in infants with original grade III IVH (n = 15, P < 0.05), but that it had no beneficial effects in infants with prior parenchymal injury (n = 17, P = NS).

Conclusion: In this small retrospective series, early EVD is associated with lower rates of cognitive, communication and social disabilities than later EVD in infants with PHH without prior parenchymal injury. A randomized prospective trial is warranted.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Birth Weight
  • Child
  • Child Development*
  • Child, Preschool
  • Disease Progression
  • Drainage
  • Female
  • Head / anatomy & histology
  • Humans
  • Hydrocephalus / etiology
  • Hydrocephalus / psychology*
  • Hydrocephalus / surgery*
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care, Neonatal
  • Intracranial Hemorrhages / complications*
  • Logistic Models
  • Male
  • Neurologic Examination
  • Neuropsychological Tests
  • Neurosurgical Procedures
  • ROC Curve
  • Treatment Outcome
  • Ventriculoperitoneal Shunt