Abstract

Background: The pathogenesis of posthaemorrhagic hydrocephalus (PHHC) following intraventricular haemorrhage (IVH) in premature infants includes a fibroproliferative reaction leading to arachnoidal fibrosis, ultimately causing malresorption of cerebrospinal fluid (CSF) at the arachnoid villi.

Aims: To determine whether an increased concentration of the carboxyterminal propeptide of type I procollagen (PICP) in the CSF of neonates after IVH reflects the activation of collagen synthesis preceding the manifestation of PHHC.

Methods: From 20 neonates with PHHC (median birth weight 740 g, median gestational age 25+1 weeks), 52 CSF samples were collected. CSF samples of four neonates (median birth weight 2170 g, median gestational age 32+4 weeks) with congenital non-haemorrhagic hydrocephalus served as controls. PICP was measured by radioimmunoassay.

Results: PICP in CSF taken at the start of external CSF drainage (median day 21, range 17–25 days postnatal age) was significantly increased (median 851.5, range 153.5–1944 μg/l) compared with controls (median 136.1, range 33.8–169.5 μg/l). CSF concentrations of PICP declined until permanent shunt placement (median day 70, range days 41–113).

Conclusion: In neonates who develop PHHC, significant elevation of PICP concentration in the CSF is present 3–4 weeks after IVH. It reflects the increase of local type I collagen turnover, thereby correlating with manifestation of PHHC.