Neonatal intraventricular hemorrhage is a serious condition associated with significant acute and long-term morbidity and mortality. Neurosurgical intervention aims to relieve life-threatening raised intracranial pressure and prevent neurological deterioration. In recent years, advancements in disease understanding have paved the way for clinicians to re-evaluate conventional approaches in the management of affected patients. Examples include various neurosurgical techniques to actively reduce blood products with a view to avoid the consequences of complex hydrocephalus and intraparenchymal injury in the developing brain. In this entry paper, we aim to provide an overview of the current perspectives, pathophysiology and management strategies for this difficult condition.
- intraventricular hemorrhage of prematurity
- neonatal intraventricular hemorrhage
- post-hemorrhagic hydrocephalus
Neonatal intraventricular hemorrhage (nIVH) refers to the occurrence of spontaneous bleeding in the lateral and third or fourth ventricles characterized by hyper-attenuating fluid within the ventricles in imaging studies [1,2,3][1][2][3]. This potentially life-threatening condition is mostly associated with preterm infants, with increasing prevalence directly proportional to decreasing gestational age and birth weight. To date, the global incidence of nIVH in preterm infants has varied widely [4,5,6][4][5][6]. A recent systematic review by Siffel et al. summarizes the prevalence of higher grade nIVH to be in the range from 5 to 52% [6,7][6][7]. Nonetheless, most agree that the exact rates of this condition in any given population are difficult to determine owing to multiple parameters, such as antenatal factors, the availability of neonatal care, birth weight, gestational age and so forth [8,9][8][9]. To a significantly lesser extent, nIVH may occur in full-term neonates, with similar concerns of permanent neurological damage [3,10][3][10]. A feared sequelae of nIVH is ventriculomegaly causing post-hemorrhagic hydrocephalus (PHH) that results in raised intracranial pressure (ICP). If left untreated, the patient is at a high risk of impaired cognitive and functional neurodevelopment [11]. As a consequence, the pediatric neurosurgeon is often referred to intervene for cerebrospinal fluid (CSF) diversion with the aims of, firstly, reducing the raised intracranial pressure, and next, preventing further brain parenchymal injury. This entry paper attempts to discuss the current perspectives, pathophysiology, neurosurgical approaches and management challenges faced in nIVH, in corroboration with the existing literature.
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