Evaluation of the treatment features of post-haemorrhagic hydrocephalus in preterm infants: a retrospective analysis of 137 patients

Vollständiger Abstract

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Background: Posthemorrhagic hydrocephalus (PHH) is one of the most severe complications of intraventricular haemorrhage (IVH) in preterm infants. PHH develops in 37.1% of infants with grades III–IV IVH and requires timely surgical correction. This study aimed to analyse the clinical characteristics, methods of temporary and permanent CSF flow correction, and outcomes in 137 preterm patients with PHH. Methods: This retrospective analysis included 137 patients with PHH hospitalised in the neonatal department and neonatal intensive care unit of Morozovskaya Children's City Clinical Hospital, Moscow, Russia (ethics reference No. L035'00115-77/00096790, 2015). Baseline data included gender, gestational age, Apgar scores, IVH grade (Papile classification), and information on temporary and permanent CSF correction methods, valve type, and complications. Descriptive statistics were performed using Python 3.11. Results: The study comprised 82 (60%) boys and 55 (40%) girls. Mean gestational age was 29.2 ± 3.3 weeks. The predominant IVH grade was III (62%). The main temporary correction methods were subgaleal shunts (61 cases, 44%), external ventricular drainage (30 cases, 22%), and Ommaya reservoirs (12 cases, 9%). Ventriculoperitoneal shunts were most frequently used for permanent correction (80 cases, 58%). Programmable valves were inserted in 77 patients (56%). Complications included hypertension syndrome (62%), retinopathy of prematurity (63%), motor disorders (48%), and seizure syndrome (39%). Complication rates increased with IVH severity. Conclusion: PHH in preterm infants is characterised by a high incidence of severe IVH, low gestational age, and frequent need for surgical correction. The predominant temporary method in our centre was the subgaleal shunt, consistent with its lower infectious risk in the literature. A multidisciplinary approach and early diagnosis are essential for optimising outcomes. Keywords: posthemorrhagic hydrocephalus; intraventricular haemorrhage; Ommaya reservoir; ventriculoperitoneal shunt; preterm infants; subgaleal shunt