V. Pierrat et al., POSTHEMORRHAGIC VENTRICULOMEGALY IN VERY-LOW-BIRTH-WEIGHT INFANTS BORN BEFORE 33 WEEKS OF GESTATIONAL-AGE - INCIDENCE AND NEURODEVELOPMENTAL OUTCOME, Archives de pediatrie, 5(9), 1998, pp. 974-981
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.