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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 …
Contributors LSdV wrote the editorial and is responsible for the overall content. AJB and FG read and amended the editorial and helped to collect the data.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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