ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Neonatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1610697
This article is part of the Research TopicAdvances and Challenges in Neonatal Surgery: Congenital and Acquired ConditionsView all 21 articles
Surgical management of intraventricular hemorrhage and posthemorrhagic hydrocephalus in premature infants -single center experience
Provisionally accepted
- 1Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czechia
- 2Department of Neonatology, University Hospital Olomouc, Olomouc, Czechia
- 3Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czechia
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IntroductionIntraventricular hemorrhage (IVH) is a severe complication of prematurity, often leading to posthemorrhagic hydrocephalus (PHH). While advances in neonatal care have reduced the incidence of IVH, managing progressive PHH remains challenging. Surgical interventions are crucial for reducing intracranial pressure and preventing long-term neurodevelopmental deficits. This study presents our single-center experience in the surgical management of IVH and PHH in premature infants, highlighting outcomes associated with different surgical strategies.MethodsThis retrospective study was conducted at a tertiary neonatal care center between 2017-2023. Premature infants (≤32 weeks of gestation or <1500 g birth weight) were screened for IVH using cranial ultrasound. IVH was graded using the modified Papile classification. Clinical data, imaging findings, and surgical outcomes were collected. Temporizing measures included ventricular access devices (VAD), ventriculosubgaleal (VSG) shunts, and external ventricular drainage (EVD), with permanent ventriculoperitoneal (VP) shunts used for long-term management. Neurodevelopmental outcomes were evaluated at one-year follow-up.ResultsThe study included 402 premature infants, of whom 75 (18.7%) were diagnosed with IVH. Among these, 6 infants developed PHH requiring surgical intervention. VAD shunting was the preferred temporizing measure due to lower infection rates, with an average duration of 35 days before conversion to VP shunting in 4 children. At one-year follow-up, 64% of infants demonstrated no significant neurological impairment, while 23.2% had severe complications, including developmental delays or motor deficits. Mortality was 20.1%, primarily in infants with Grade III-IV IVH. Logistic regression analysis identified gestational age, corticosteroid treatment, and inborn status as significant predictors of favorable outcomes.ConclusionEffective surgical management of PHH in premature infants hinges on timely diagnosis, early intervention, and appropriate selection of temporizing measures. Ventricular access devices (VAD ) offer a safe and effective strategy to stabilize infants before permanent shunt placement, minimizing complications and improving long-term outcomes. Close collaboration between neonatologists and neurosurgeons remains essential to optimizing care and reducing morbidity in this high-risk population.
Keywords: Intraventricular haemorrhage, newborns, Hydrocephalus, Neonatal neurosurgery, premature infants
Received: 12 Apr 2025; Accepted: 15 Jul 2025.
Copyright: © 2025 Krahulik, Wita, Volkova, Halek, Krahulik and Blazek. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: David Krahulik, Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czechia
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