gms | German Medical Science

Objective: Posthemorrhagic hydrocephalus (PHH) is a rare but serious complicationamong premature babies in the neonatal intensive care unit, with consequences including mortality and severe neurodevelopmental disabilities. The causes of PHH are still not entirely understood, and its prevention and treatment are controversial. We tried to analyse the risk factors for such complication in our cohort.

Methods: We reviewed our neonatology data bank and included all patients who were born in the period from 1999 - 2014 with a gestational age below 28 weeks and suffered from an intraventricular hemorrhage of any degree. The following data were collected: date of birth, gestational age, gender, birth weight, type of birth, IVH degree (I-IV), comorbidities, therapy measures, complications, period from first diagnosis PHH to implantation of a VP shunt, protein content of cerebrospinal fluid content before shunt implantation, clinical follow-up. All patients with a follow-up period of less than one year were excluded from the study.

Results: We identified 180 patients, the cohort was divided into two subgroups, "B1" with 37 cases (patients with IVH and development of a PHH requiring therapy) and "B2" with 143 cases (patients with IVH, but without development of PHH). In group B1, the average gestational age was 25 weeks + 3 days of gestation. 11% of patients had an IVH grade I, 19% IVH grade II and 70% an IVH III. or IV. degrees. 19 patients were treated with a Rickham reservoir or EVD. A total of 19 shunts were implanted, with 11 revisions (58%). Unfortunately, 10 patients (27%) die, only 1 patient in this group from thrombocytopenia. In subgroup B2, the average age was also 25 weeks + 3 days of gestation. The majority of patients showed 51% IVH grade I, whereas severe IVH grade III was only present in 22%. 25.9% suffered from thrombocytopenia. The IVH grade showed strong significance (p-value: 0.0005). We found thrombocytopenia significantly higher in patients who did not develop PHH (p-value: 0.002).

Conclusion: According to our results, thrombocytopenia could play a decisive role in avoiding development of PHH as a sequel of IVH. We recommend a randomized controlled trial to assess efficacy of antiplatelet drugs in avoiding PHH in this vulnerable group.