548 - Evaluation of Early Intervention Strategy for Post Hemorrhagic Ventricular Dilation: A two-year review

Poster Number: 548
Publication Number: 548.1504

Background: Post-hemorrhagic ventricular dilatation (PHVD) is a common complication of severe intraventricular hemorrhage in preterm infants. Effective treatment of PHVD may mitigate secondary brain injury and improve long term neurodevelopmental outcomes. There is significant variability in the timing and approach to intervention, internationally. Previously institutional data of a late intervention approach showed a high rate of VP shunt insertion, and poor cognitive and motor outcomes, providing the impetus for the development of this protocol.

Objective: To report short and long term outcomes of preterm infants with post hemorrhagic ventricular dilation (PHVD) who underwent an early intervention, protocol based, strategy to mitigate progression of PHVD over a two-year time.

Design/Methods: Multicenter, prospective, interventional quality improvement study.

Following the developmental of a standardized early intervention protocol, this quality improvement protocol was developed and implemented across three (level 3/4 ) institutions, including 100 babies at < 32 weeks gestation at birth who sustained grade III or higher intraventricular hemorrhage (IVH). Ventricular size was assessed using standardized measurements. Outcomes at 36 months of age were evaluated using the Bayley Scales of Infant and Toddler Development (Bayley-III).

Results: One hundred patients fulfilled inclusion criteria, mean GA 25 weeks, range 23-32. There was a 30% mortality rate in our cohort, all of whom died from complications of prematurity with 23% of patients who had a gestational age less than 24 weeks. Of the 71 survivors, there were 30 who resolved with no active intervention (42%). Twenty-seven responded to lumbar puncture alone (38%), 3 (4%) babies received lumbar puncture (LP) and then an Ommaya reservoir was inserted and tapped regularly, until the time of discharge from our hospital. Eleven babies (16%) had LP, Ommaya reservoir and ultimately required a ventricular peritoneal (VP) shunt. Our complication rate over the two-year period was 3% from all procedures. Three year outcome data are pending.

Conclusion(s): Early intervention for PHVD may mitigate the need for surgical intervention as shown in 38% of this cohort, and reduce the incidence of ventricular-peritoneal (VP) shunt requirement. There was a high mortality rate in our cohort (30%), unrelated to protocol interventions. Standardized neurodevelopmental evaluation at 36-months will provide further insight into the role of early intervention for PHVD with a protocol based approach, regardless of the ultimate intervention.