POSTHEMORRHAGIC VENTRICULOMEGALY IN VERY-LOW-BIRTH-WEIGHT INFANTS BORN BEFORE 33 WEEKS OF GESTATIONAL-AGE - INCIDENCE AND NEURODEVELOPMENTAL OUTCOME

Background. - Posthemorrhagic ventriculomegaly is one of the most impo rtant neurological problems encountered in the premature new-bent. The aim of this study was to evaluate its incidence in a tertiary neonata l unit at Lille, France, to study its evolution, the risk of ventricul operitoneal shunt and the neurodevelopmental outcome. Patients and met hods. - Ninety-one neonates with posthemorrhagic ventriculomegaly, bor n before 33 weeks of gestational age (GA) and admitted in this unit be tween January 1989 and December 1995 were retrospectively studied. Cli nical data, evolution of ventriculomegaly and outcome at 2 years were extracted from the files. Results. - incidence of ventriculomegaly was stable along the study period, around 6.1% of the admissions of neona tes with the same GA; 44 had moderate ventriculomegaly and 47 severe. The mean GA was 28.7 +/- 1.9 weeks. Fifteen percent of the newborns ha d received corticosteroids before delivery. Spontaneous delivery (P = 0.04) and infection (P = 0.002) were more frequent in case of severe v entriculomegaly. Ventriculoperitoneal shunt was inserted in 19.1% (9/4 7) of infants with severe ventriculomegaly. Outcome in this population was poor. Forty-nine (54%) died before the end of the first year of l ife. Thirteen (30.9%) of the survivors developed cerebral palsy. In 12 out of these 13 cases, cerebral palsy was associated with parenchymal involvement in the neonatal period.Conclusion. - Long-term prognosis of ventriculomegaly is poor. In front of new therapeutic approach an a ctive policy towards prevention with large use of antenatal corticoste roids would allow to reduce incidence, mortality and morbidity in the neonatal period (C) 1998 Elsevier, Paris.