Published online April 7, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. e1167-e1177 (doi:10.1542/10.1542/peds.2007-0423)
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ARTICLE

Neurodevelopmental Outcome of Extremely Low Birth Weight Infants With Posthemorrhagic Hydrocephalus Requiring Shunt Insertion

Ira Adams-Chapman, MDa, Nellie I. Hansen, MPHb, Barbara J. Stoll, MDa, Rose Higgins, MDc for the NICHD Research Network

a Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
b RTI International, Research Triangle Park, North Carolina
c Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland

OBJECTIVE. We aimed to evaluate neurodevelopmental and growth outcomes among extremely low birth weight infants who had severe intraventricular hemorrhage that required shunt insertion compared with infants without shunt insertion.

METHODS. Infants who were born in 1993–2002 with birth weights of 401 to 1000 g were enrolled in a very low birth weight registry at medical centers that participate in the National Institute of Child Health and Human Development Neonatal Research Network, and returned for follow-up at 18 to 22 months' corrected age were studied. Eighty-two percent of survivors completed follow-up, and 6161 children were classified into 5 groups: group 1, no intraventricular hemorrhage/no shunt (n = 5163); group 2, intraventricular hemorrhage grade 3/no shunt (n = 459); group 3, intraventricular hemorrhage grade 3/shunt (n = 103); group 4, intraventricular hemorrhage grade 4/no shunt (n = 311); and group 5, intraventricular hemorrhage grade 4/shunt (n = 125). Group comparisons were evaluated with {chi}2 and Wilcoxon tests, and regression models were used to compare outcomes after adjustment for covariates.

RESULTS. Children with severe intraventricular hemorrhage and shunts had significantly lower scores on the Bayley Scales of Infant Development IIR compared with children with no intraventricular hemorrhage and with children with intraventricular hemorrhage of the same grade and no shunt. Infants with shunts were at increased risk for cerebral palsy and head circumference at the <10th percentile at 18 months' adjusted age. Greatest differences were observed between children with shunts and those with no intraventricular hemorrhage on these outcomes.

CONCLUSIONS. This large cohort study suggests that extremely low birth weight children with severe intraventricular hemorrhage that requires shunt insertion are at greatest risk for adverse neurodevelopmental and growth outcomes at 18 to 22 months compared with children with and without severe intraventricular hemorrhage and with no shunt. Long-term follow-up is needed to determine whether adverse outcomes persist or improve over time.

Key Words: hydrocephalus • neuromotor outcome • prematurity

Abbreviations: ELBW—extremely low birth weight • IVH—intraventricular hemorrhage • GA—gestational age • PHH—posthemorrhagic hydrocephalus • GDB—Generic Database • ROM—rupture of membranes • HC—head circumference • RDS—respiratory distress syndrome • PDA—patent ductus arteriosus • PVL—periventricular leukomalacia • CLD/BPD—chronic lung disease or bronchopulmonary dysplasia • NEC—necrotizing enterocolitis • PCA—postconceptional age • CSF—cerebrospinal fluid • MDI—Mental Development Index • PDI—Psychomotor Development Index • NDI—neurodevelopmental impairment • CP—cerebral palsy • RR—relative risk • CI—confidence interval • IL—interleukin

Accepted Oct 10, 2007.


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