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01-11-2017 | Original Paper

Time-to-event analysis of surgically treated posthemorrhagic hydrocephalus in preterm infants: a single-institution retrospective study

Authors: Rowland H. Han, Daniel Berger, Mohamed Gabir, Brandon S. Baksh, Diego M. Morales, Amit M. Mathur, Christopher D. Smyser, Jennifer M. Strahle, David D. Limbrick Jr.

Published in: Child's Nervous System | Issue 11/2017

Abstract

Purpose

The purpose of this study is to report time points relevant to the neurosurgical management of posthemorrhagic hydrocephalus (PHH).

Methods

Data were collected retrospectively on 104 preterm infants with intraventricular hemorrhage (IVH) who received neurosurgical intervention for PHH at St. Louis Children’s Hospital from 1994 to 2016. Kaplan-Meier curves were constructed for various endpoints.

Results

IVH grade on head ultrasound obtained through routine clinical care was II, III, and IV in 5 (4.8%), 33 (31.7%), and 66 (63.5%) of the patients, respectively. Neither IVH size nor location appeared to affect development of PHH. Days from birth to IVH, ventriculomegaly, temporizing neurosurgical procedure (TNP), and permanent neurosurgical intervention were 2.0 (95% CI 1.7–2.3), 3.0 (2.5–3.5), 24.0 (22.2–25.8), and 101.0 (90.4–111.6), respectively. Grades III and IV IVH did not differ in age at IVH diagnosis (Χ ² (1 d.f.) = 1.32, p = 0.25), ventriculomegaly (Χ ² = 0.73, p = 0.40), TNP (Χ ² = 0.61, p = 0.43), or permanent intervention (Χ ² = 2.48, p = 0.17). Ventricular reservoirs and ventriculosubgaleal shunts were used in 71 (68.3%) and 30 (28.8%), respectively. Eighty (76.9%) of the patients ultimately received a VPS. Five (4.8%) underwent a primary endoscopic third ventriculostomy (ETV), and two (1.9%) had ETV for a revision procedure. Four of the seven ETVs had choroid plexus cauterization.

Conclusions

Although most infants who develop IVH and ventriculomegaly will do so within a few days of birth, at-risk infants should be observed for at least 4 weeks with serial head ultrasounds to monitor for PHH requiring surgery.

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Title: Time-to-event analysis of surgically treated posthemorrhagic hydrocephalus in preterm infants: a single-institution retrospective study
Authors: Rowland H. Han
Daniel Berger
Mohamed Gabir
Brandon S. Baksh
Diego M. Morales
Amit M. Mathur
Christopher D. Smyser
Jennifer M. Strahle
David D. Limbrick Jr.
Publication date: 01-11-2017
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 11/2017
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-017-3588-6

At a glance: The STEP trials

Springer Medicine

Time-to-event analysis of surgically treated posthemorrhagic hydrocephalus in preterm infants: a single-institution retrospective study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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