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Germinal matrix haemorrhage–intraventricular haemorrhage (GMH–IVH) remains a common neurological complication of preterm birth, occurring in about 10–20% of preterm infants with a gestational age (GA) below 30 weeks and is predictive of an adverse neurological outcome.1 About 30–50% of infants with a large IVH develop posthaemorrhagic ventricular dilatation (PHVD) and around 20–40% of infants with a severe GMH–IVH will consequently need a permanent ventriculo-peritoneal shunt.1 ,2 The presence of associated white matter injury, due to either a unilateral parenchymal haemorrhage or a more diffuse bilateral white matter damage, and development of PHVD increase the risk of an adverse neurodevelopmental outcome. Around 45–60% of infants with PHVD have marked cognitive impairment (developmental quotient equivalent of less than 70).1
When to intervene with drainage of cerebrospinal fluid is a challenge for the neonatologists who care for them. In an accompanying article, Klebermass-Schrehof and colleagues address this question, when to intervene?2 As they have shown previously,3 several neurophysiological parameters may change in preterm infants with PHVD following a large IVH. Recording amplitude-integrated EEG (aEEG) and visual-evoked potentials (VEPs) before and after insertion of a ventricular reservoir, they found deterioration in aEEG background pattern and an increase in VEP latency with progressive ventricular dilatation and improvement in these parameters within a week of insertion of the reservoir. Their findings are especially interesting as most of the infants they studied showed …
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