Victor Garcia-Navarro1, Carlos Perez-Vega2, Pilar Robles-Lomelín2, Paola Valdez-Sandoval2, Paola M Garnica Vazquez3, Yazmin Lemus Rodriguez4, Silvia G Leon Cortes5, Eva Chavana Naranjo6. 1. Tecnologico De Monterrey, School of Medicine and Health Sciences, Guadalajara campus, Zapopan, Jalisco, México; Department of Neurology and Neurosurgery, Instituto Neurológico de Guadalajara S.C., Guadalajara, Jalisco, México; Department of Neurosurgery, Nuevo Hospital Civil de Guadalajara Juan I. Menchaca OPD, Guadalajara, Jalisco, México. Electronic address: garcianavarrov@tec.mx. 2. Tecnologico De Monterrey, School of Medicine and Health Sciences, Guadalajara campus, Zapopan, Jalisco, México. 3. Department of Neonatology, Nuevo Hospital Civil de Guadalajara Juan I. Menchaca OPD, Guadalajara, Jalisco, México. 4. Department of Neurosurgery, Nuevo Hospital Civil de Guadalajara Juan I. Menchaca OPD, Guadalajara, Jalisco, México. 5. Centro Universitario de Ciencias de la Salud CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, México. 6. Department of Neonatology, Nuevo Hospital Civil de Guadalajara Juan I. Menchaca OPD, Guadalajara, Jalisco, México; Centro Universitario de Ciencias de la Salud CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, México.
Abstract
OBJECTIVE: Intraventricular hemorrhage (IVH) is the most common central nervous system pathology in preterm infants. No consensus has been reached over the best indication for intervention in patients with posthemorrhagic hydrocephalus (PHH). The authors present the neurological outcome of infants with IVH and an early treatment approach, defined as an intervention when ventricular dilation is less than 4-mm over the 97th-percentile of Levene's index. METHODS: We performed a retrospective case-series study of 12 infants who had IVH and an early intervention, their neurological development was evaluated after 18-months of corrected age using the Bayley-III Scales. Measures of central tendency and Pearson's correlation were used for data analysis. RESULTS: In a 15-month period, twelve patients were diagnosed with IVH and underwent an early intervention. At the time of diagnosis, 2 patients had grade II IVH, 7 grade III, and 3 grade IV. Subgaleal shunt was the first intervention. 9 (75 %) ultimately required a ventriculoperitoneal shunt. A total of 9 (75 %) patients had normal cognitive scores, 7 (58.3 %) for the language-composite, and 8 (66.7 %) for the motor-composite. 6 (50 %) patients had normal scores in all composites. The average scores reported normal results (CC:98.33 ± 22.59; LC:98.25 ± 23.93; MC:88.58 ± 21.47). There was a significant correlation between antenatal steroids and the LC-score (p = 0.044). CONCLUSIONS: Half of the patients with PHH and early neurosurgical interventions had an average or above average neurodevelopmental score in all three areas. Current literature and undergoing clinical trials have shown promising results on the implementation of this type of intervention.
OBJECTIVE: Intraventricular hemorrhage (IVH) is the most common central nervous system pathology in preterm infants. No consensus has been reached over the best indication for intervention in patients with posthemorrhagic hydrocephalus (PHH). The authors present the neurological outcome of infants with IVH and an early treatment approach, defined as an intervention when ventricular dilation is less than 4-mm over the 97th-percentile of Levene's index. METHODS: We performed a retrospective case-series study of 12 infants who had IVH and an early intervention, their neurological development was evaluated after 18-months of corrected age using the Bayley-III Scales. Measures of central tendency and Pearson's correlation were used for data analysis. RESULTS: In a 15-month period, twelve patients were diagnosed with IVH and underwent an early intervention. At the time of diagnosis, 2 patients had grade II IVH, 7 grade III, and 3 grade IV. Subgaleal shunt was the first intervention. 9 (75 %) ultimately required a ventriculoperitoneal shunt. A total of 9 (75 %) patients had normal cognitive scores, 7 (58.3 %) for the language-composite, and 8 (66.7 %) for the motor-composite. 6 (50 %) patients had normal scores in all composites. The average scores reported normal results (CC:98.33 ± 22.59; LC:98.25 ± 23.93; MC:88.58 ± 21.47). There was a significant correlation between antenatal steroids and the LC-score (p = 0.044). CONCLUSIONS: Half of the patients with PHH and early neurosurgical interventions had an average or above average neurodevelopmental score in all three areas. Current literature and undergoing clinical trials have shown promising results on the implementation of this type of intervention.