Emergency Med Medical News about Intraventricular Hemorrhage

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Functional Outcomes among Premature Infants with Intraventricular Hemorrhage
Pediatric Neurosurgery, 07/20/09

Vassilyadi M et al. – This study describes a large cohort of neonatal IVH, describing how disease severity affects mortality and functional outcome. The overall mortality of nearly 1 in 5 patients is primarily of grade IV patients, with no difference between grade II and grade III.

Exclusive Author Commentary
Dr. M. Vassilyadi, 07/26/09

Posthemorrhagic hydrocephalus is a sequela of IVH and can usually be predicted by the severity of the IVH. However, it is difficult to predict the likelihood of shunting. 21% of the neonates developed hydrocephalus and 39% required a VP shunt. The importance of the study was that is showed there was no difference in the long-term functional outcomes in children with respect to the neonatal management of hydrocephalus (i.e., medical treatment versus insertion of VP shunt). The other important point made in the paper was that the presence of hydrocephalus is a predictor of worse outcome; 24% of children with a history of neonatal hydrocephalus had a "good" outcome versus 50% without hydrocephalus. An important contributor towards a worse long-term outcome that was not addressed in this paper is periventricular leukomalacia. Finally, grade IV IVH patients are a heterogeneous group that need to be subcategorized in order to help predict outcome.

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