Ventricular dilation after neonatal periventricular-intraventricular hemorrhage. Natural history and therapeutic implications
W. C. Allan, P. J. Holt, L. R. Sawyer, A. M. Tito and S. K. Meade
Infants with periventricular-intraventricular hemorrhage (PV-IVH) were
followed up with weekly ultrasound sector scans to define the natural
history of late ventricular dilation (ie, dilation in excess of that seen
at the time of diagnosis of PV-IVH). Infants fell into two groups: (1)
posthemorrhagic hydrocephalus (PHH), dilation that produced an increase in
occipitofrontal circumference greater than 2 cm per week and/or clinical
symptoms of increased intracranial pressure; and (2) ventriculomegaly (VM),
dilation that stabilized or reversed without producing these effects. The
former was directly related to the severity of hemorrhage. The diameter of
the lateral ventricle was significantly greater in PHH. In 26 of 48 infants
at risk, late dilation developed: 14 had VM and 12 had PHH. Thus, late
ventricular dilation stabilized or resolved spontaneously in 54%. Only
three infants eventually required a ventriculoperitoneal shunt. Clinical
changes in addition to ventricular size should be used in assessing the
need for treatment of ventricular dilation after PV-IVH.
