Neonatal Hemorrhagic Brain Injury: Optimizing Treatment and Outcome

Abstract

In infants with post-hemorrhagic ventricular dilatation (PHVD), earlier interventions to bring the intraventricular pressure, therefore the ventricular size, down based on ultrasonographic assessments result in smaller ventricular volumes and less brain injury at term-equivalent age. PHVD also causes impaired microstructure of the critical brain structures in extremely preterm infants. Thus, earlier interventions for PHVD based on ultrasonographic assessments also result in reduced composite outcome of mortality and neurodevelopmental disability at 2 years corrected age. In infants with PHVD, rapid reduction of the ventricular pressure and volume during the first week after the commencement of serial reservoir taps may result in intraparenchymal hemorrhage (IPH) in the periventricular and/or subcortical white matter tissues, and these IPHs can affect cognitive outcomes when multifocal. Therefore, it is essential to perform serial cUS scans to guide the amount of cerebrospinal fluid removal via reservoir taps. Neurosurgical interventions, especially reservoir insertions, can cause injury to the CC and subsequent thinning of the CC. However, this phenomenon does not appear to be related to impaired neurodevelopmental outcomes at 2 years of age.

Periventricular hemorrhagic infarction (PVHI), a severe form of germinal matrix and intraventricular hemorrhage continues to be a significant complication in very preterm infants and is an independent risk factor for both cognitive and motor impairment at 2 years corrected age and cognitive and motor outcomes are within the normal range in two-thirds, and cerebral palsy (CP) is seen in around 40% of PVHI survivors at 2 years corrected age. The majority (81%) of infants with CP can walk independently. These neurodevelopmental findings appear more favorable when compared to previous studies conducted more than a decade ago.