Pediatria pre prax 1/2021

Up-to-date trends in treatment of intraventricular hemorrhage in newborns

Despite continuous medical progress in neonatal intensive care intraventricular hemorrhage (IVH) is still a major cause of mortality and morbidity in term and preterm infants. The risk of IVH is inversely related to the preterm infant’s gestational age, with the most premature infants at highest risk. Higher grades of IVH are associated with more severe neurodevelopmental sequelae due to white matter lesions. In addition to the primary damage to the brain parenchyma, there is also potential secondary damage caused by posthemorrhagic hydrocephalus and white matter injury due by pressure, distortion, free radical injury, inflammation and detrimental effects of intraventricular blood degradation products. Various temporizing neurosurgical interventions are used to achieve a controlled drainage of cerebrospinal fluid (CSF) during the acute state of IVH. Neuroendoscopic lavage (NEL) is a novel approach to remove hematoma and blood products from the ventricular system, which may help prevent disruption of CSF absorption due to venous occlusion. Additionally, distending of the ventricular system and consecutive development of venous infarction of the underlying white matter may be reduced. However, decreasing the number of permanent shunt insertion by half compared to previously used interventions seems to be the most important advantage of NEL. These positive results will be further investigated and compared in an ongoing prospective international multicenter study.

Keywords: intraventricular hemorrhage in preterm infants, IVH, posthemorrhagic hydrocephalus, germinal matrix hemorrhage, posthemorrhagic hydrocephalus in preterm infants, periventricular hemorrhagic infarction