scholarly journals Intraventricular Hemorrhage Clearance in Human Neonatal Cerebrospinal Fluid

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1712-1719 ◽  
Author(s):  
Kelly B. Mahaney ◽  
Chandana Buddhala ◽  
Mounica Paturu ◽  
Diego Morales ◽  
David D. Limbrick ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Lumbar Puncture ◽  
Intraventricular Hemorrhage ◽  
Total Bilirubin ◽  
Preterm Neonates ◽  
Low Grade ◽  
Cranial Ultrasound ◽  
High Grade ◽  
Posthemorrhagic Hydrocephalus ◽  
Fluid Blood

Background and Purpose— Preterm neonates with intraventricular hemorrhage (IVH) are at risk for posthemorrhagic hydrocephalus and poor neurological outcomes. Iron has been implicated in ventriculomegaly, hippocampal injury, and poor outcomes following IVH. We hypothesized that levels of cerebrospinal fluid blood breakdown products and endogenous iron clearance proteins in neonates with IVH differ from those of neonates with IVH who subsequently develop posthemorrhagic hydrocephalus. Methods— Premature neonates with an estimated gestational age at birth <30 weeks who underwent lumbar puncture for clinical evaluation an average of 2 weeks after birth were evaluated. Groups consisted of controls (n=16), low-grade IVH (grades I–II; n=4), high-grade IVH (grades III–IV; n=6), and posthemorrhagic hydrocephalus (n=9). Control subjects were preterm neonates born at <30 weeks’ gestation without brain abnormality or hemorrhage on cranial ultrasound, who underwent lumbar puncture for clinical purposes. Cerebrospinal fluid hemoglobin, total bilirubin, total iron, ferritin, ceruloplasmin, transferrin, haptoglobin, and hemopexin were quantified. Results— Cerebrospinal fluid hemoglobin levels were increased in posthemorrhagic hydrocephalus compared with high-grade IVH (9.45 versus 6.06 µg/mL, P <0.05) and cerebrospinal fluid ferritin levels were increased in posthemorrhagic hydrocephalus compared with controls (511.33 versus 67.08, P <0.01). No significant group differences existed for the other cerebrospinal fluid blood breakdown and iron-handling proteins tested. We observed positive correlations between ventricular enlargement (frontal occipital horn ratio) and ferritin (Pearson r =0.67), hemoglobin (Pearson r =0.68), and total bilirubin (Pearson r =0.69). Conclusions— Neonates with posthemorrhagic hydrocephalus had significantly higher levels of hemoglobin than those with high-grade IVH. Levels of blood breakdown products, hemoglobin, ferritin, and bilirubin correlated with ventricular size. There was no elevation of several iron-scavenging proteins in cerebrospinal fluid in neonates with posthemorrhagic hydrocpehalus, indicative of posthemorrhagic hydrocephalus as a disease state occurring when endogenous iron clearance mechanisms are overwhelmed.

scholarly journals Clinical Presentation of Preterm Neonates with Intraventricular Hemorrhage: Experience in a Tertiary Care Hospital in Dhaka

2017 ◽  
Vol 7 (3) ◽  
pp. 194-197
Author(s):  
Tasnima Ahmed ◽  
Abdul Baki ◽  
Tahmina Begum ◽  
Nazmun Nahar
Keyword(s):  
Clinical Features ◽  
Intraventricular Hemorrhage ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Sudden Onset ◽  
Morbidity And Mortality ◽  
Preterm Neonates ◽  
Cranial Ultrasound ◽  
Care Hospital ◽  
One Year

Background: Intraventricular hemorrhage (IVH) is common among preterm infants as many of them survive with the advancements in neonatal care. Severe IVH may lead to significant morbidity and mortality. The objective of our study is to find out the significant clinical signs of IVH in preterm neonate for early detection by ultrasonography.Methods: This prospective observational study was done in special care baby unit (SCABU), Bangladesh Institute of Research & rehabilitation of Diabetic, Endocrine & metabolic Disorder (BIRDEM) for a period of one year. Eighty five preterm neonates were included in this study. Clinical features of IVH like- convulsion, lethargy, irritability, bulged fontanelle, recurrent apnea, sudden onset of respiratory distress, sudden pallor and bradycardia were observed. Cranial ultrasound studies were done within 7 days of life in all cases to identify IVH.Result: Mean gestational age of these neonates was 31.31(±2.2) weeks & mean birth weight was 1413.42 (±330.55) gm. Among 85 preterm neonates 21(24.7%) developed IVH, confirmed by ultrasonography of brain. Clinical features like convulsion, bulged fontanel, repeated apnea & sudden pallor were significantly present in IVH group.Conclusion: Intraventricular Hemorrhage constitutes an important cause of morbidity and mortality in neonate. This study showed that clinical features like convulsion, bulged fontanel and sudden pallor had a significant relationship with intraventricular hemorrhage which will help for its early detection.Birdem Med J 2017; 7(3): 194-197

scholarly journals Germinal Matrix-Intraventricular Hemorrhage: A Tale of Preterm Infants

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Walufu Ivan Egesa ◽  
Simon Odoch ◽  
Richard Justin Odong ◽  
Gloria Nakalema ◽  
Daniel Asiimwe ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Very Low Birth Weight ◽  
Preterm Neonates ◽  
Low Birth Weight Infants ◽  
Neurodevelopmental Outcomes ◽  
Germinal Matrix ◽  
Posthemorrhagic Hydrocephalus ◽  
Management Interventions ◽  
Incidence Risk

Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.

scholarly journals Does ventricle size contribute to cognitive outcomes in posthemorrhagic hydrocephalus? Role of early definitive intervention

2021 ◽  
pp. 1-11
Author(s):  
Mounica Paturu ◽  
Regina L. Triplett ◽  
Siddhant Thukral ◽  
Dimitrios Alexopoulos ◽  
Christopher D. Smyser ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Brain Mri ◽  
Neurodevelopmental Outcome ◽  
Optimal Time ◽  
Preterm Neonates ◽  
Third Ventriculostomy ◽  
Cranial Ultrasound ◽  
Ventricular Size ◽  
Posthemorrhagic Hydrocephalus ◽  
Ventricle Size

OBJECTIVE Posthemorrhagic hydrocephalus (PHH) is associated with significant morbidity, smaller hippocampal volumes, and impaired neurodevelopment in preterm infants. The timing of temporary CSF (tCSF) diversion has been studied; however, the optimal time for permanent CSF (pCSF) diversion is unknown. The objective of this study was to determine whether cumulative ventricle size or timing of pCSF diversion is associated with neurodevelopmental outcome and hippocampal size in preterm infants with PHH. METHODS Twenty-five very preterm neonates (born at ≤ 32 weeks’ gestational age) with high-grade intraventricular hemorrhage (IVH), subsequent PHH, and pCSF diversion with a ventriculoperitoneal shunt (n = 20) or endoscopic third ventriculostomy (n = 5) were followed until 2 years of age. Infants underwent serial cranial ultrasounds from birth until 1 year after pCSF diversion, brain MRI at term-equivalent age, and assessment based on the Bayley Scales of Infant and Toddler Development, Third Edition, at 2 years of age. Frontooccipital horn ratio (FOHR) measurements were derived from cranial ultrasounds and term-equivalent brain MRI. Hippocampal volumes were segmented and calculated from term-equivalent brain MRI. Cumulative ventricle size until the time of pCSF diversion was estimated using FOHR measurements from each cranial ultrasound performed prior to permanent intervention. RESULTS The average gestational ages at tCSF and pCSF diversion were 28.9 and 39.0 weeks, respectively. An earlier chronological age at the time of pCSF diversion was associated with larger right hippocampal volumes on term-equivalent MRI (Pearson’s r = −0.403, p = 0.046) and improved cognitive (r = −0.554, p = 0.047), motor (r = −0.487, p = 0.048), and language (r = −0.414, p = 0.021) outcomes at 2 years of age. Additionally, a smaller cumulative ventricle size from birth to pCSF diversion was associated with larger right hippocampal volumes (r = −0.483, p = 0.014) and improved cognitive (r = −0.711, p = 0.001), motor (r = −0.675, p = 0.003), and language (r = −0.618, p = 0.011) outcomes. There was no relationship between time to tCSF diversion or cumulative ventricle size prior to tCSF diversion and neurodevelopmental outcome or hippocampal size. Finally, a smaller cumulative ventricular size prior to either tCSF diversion or pCSF diversion was associated with a smaller ventricular size 1 year after pCSF diversion (r = 0.422, p = 0.040, R2 = 0.178 and r = 0.519, p = 0.009, R2 = 0.269, respectively). CONCLUSIONS In infants with PHH, a smaller cumulative ventricular size and shorter time to pCSF diversion were associated with larger right hippocampal volumes, improved neurocognitive outcomes, and reduced long-term ventriculomegaly. Future prospective randomized studies are needed to confirm these findings.

scholarly journals Tract-Specific Relationships Between Cerebrospinal Fluid Biomarkers and Periventricular White Matter in Posthemorrhagic Hydrocephalus of Prematurity

Neurosurgery ◽  
2020 ◽  
Author(s):  
Diego M Morales ◽  
Christopher D Smyser ◽  
Rowland H Han ◽  
Jeanette K Kenley ◽  
Joshua S Shimony ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cell Adhesion ◽  
White Matter ◽  
Lumbar Puncture ◽  
Mean Diffusivity ◽  
White Matter Injury ◽  
Csf Biomarkers ◽  
Periventricular White Matter ◽  
Posthemorrhagic Hydrocephalus ◽  
Posterior Limb

Abstract BACKGROUND Posthemorrhagic hydrocephalus (PHH) is associated with neurological morbidity and complex neurosurgical care. Improved tools are needed to optimize treatments and to investigate the developmental sequelae of PHH. OBJECTIVE To examine the relationship between diffusion magnetic resonance imaging (dMRI) and cerebrospinal fluid (CSF) biomarkers of PHH. METHODS A total of 14 preterm (PT) infants with PHH and 46 controls were included. PT CSF was collected at temporizing surgery in PHH infants (PHH PT CSF) or lumbar puncture in controls. Term-equivalent age (TEA) CSF was acquired via implanted device or at permanent CSF diversion surgery in PHH (PHH-TEA-CSF) or lumbar puncture in controls. TEA dMRI scans were used to measure fractional anisotropy (FA) and mean diffusivity (MD) in the genu of corpus callosum (gCC), posterior limb of internal capsule (PLIC), and optic radiations (OPRA). Associations between dMRI measures and CSF amyloid precursor protein (APP), neural cell adhesion-1 (NCAM-1), and L1 cell adhesion molecule (L1CAM) were assessed using Pearson correlations. RESULTS APP, NCAM-1, and L1CAM were elevated over controls in PHH-PT-CSF and PHH-TEA-CSF. dMRI FA and MD differed between control and PHH infants across all tracts. PHH-PT-CSF APP levels correlated with gCC and OPRA FA and PLIC MD, while L1CAM correlated with gCC and OPRA FA. In PHH-TEA-CSF, only L1CAM correlated with OPRA MD. CONCLUSION Tract-specific associations were observed between dMRI and CSF biomarkers at the initiation of PHH treatment. dMRI and CSF biomarker analyses provide innovative complementary methods for examining PHH-related white matter injury and associated developmental sequelae.

scholarly journals Biochemical profile of human infant cerebrospinal fluid in intraventricular hemorrhage and post-hemorrhagic hydrocephalus of prematurity

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ayodamola Otun ◽  
Diego M. Morales ◽  
Maria Garcia-Bonilla ◽  
Seth Goldberg ◽  
Leandro Castaneyra-Ruiz ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Total Protein ◽  
Intraventricular Hemorrhage ◽  
Ventricular Zone ◽  
Human Infant ◽  
Low Grade ◽  
Serum Electrolyte ◽  
Sodium Potassium ◽  
Cell Counts ◽  
Control Serum

Abstract Background Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) have a complex pathophysiology involving inflammatory response, ventricular zone and cell–cell junction disruption, and choroid-plexus (ChP) hypersecretion. Increased cerebrospinal fluid (CSF) cytokines, extracellular matrix proteins, and blood metabolites have been noted in IVH/PHH, but osmolality and electrolyte disturbances have not been evaluated in human infants with these conditions. We hypothesized that CSF total protein, osmolality, electrolytes, and immune cells increase in PHH. Methods CSF samples were obtained from lumbar punctures of control infants and infants with IVH prior to the development of PHH and any neurosurgical intervention. Osmolality, total protein, and electrolytes were measured in 52 infants (18 controls, 10 low grade (LG) IVH, 13 high grade (HG) IVH, and 11 PHH). Serum electrolyte concentrations, and CSF and serum cell counts within 1-day of clinical sampling were obtained from clinical charts. Frontal occipital horn ratio (FOR) was measured for estimating the degree of ventriculomegaly. Dunn or Tukey’s post-test ANOVA analysis were used for pair-wise comparisons. Results CSF osmolality, sodium, potassium, and chloride were elevated in PHH compared to control (p = 0.012 − < 0.0001), LGIVH (p = 0.023 − < 0.0001), and HGIVH (p = 0.015 − 0.0003), while magnesium and calcium levels were higher compared to control (p = 0.031) and LGIVH (p = 0.041). CSF total protein was higher in both HGIVH and PHH compared to control (p = 0.0009 and 0.0006 respectively) and LGIVH (p = 0.034 and 0.028 respectively). These differences were not reflected in serum electrolyte concentrations nor calculated osmolality across the groups. However, quantitatively, CSF sodium and chloride contributed 86% of CSF osmolality change between control and PHH; and CSF osmolality positively correlated with CSF sodium (r, p = 0.55,0.0015), potassium (r, p = 0.51,0.0041), chloride (r, p = 0.60,0.0004), but not total protein across the entire patient cohort. CSF total cells (p = 0.012), total nucleated cells (p = 0.0005), and percent monocyte (p = 0.016) were elevated in PHH compared to control. Serum white blood cell count increased in PHH compared to control (p = 0.042) but there were no differences in serum cell differential across groups. CSF total nucleated cells also positively correlated with CSF osmolality, sodium, potassium, and total protein (p = 0.025 − 0.0008) in the whole cohort. Conclusions CSF osmolality increased in PHH, largely driven by electrolyte changes rather than protein levels. However, serum electrolytes levels were unchanged across groups. CSF osmolality and electrolyte changes were correlated with CSF total nucleated cells which were also increased in PHH, further suggesting PHH is a neuro-inflammatory condition.

Angiogenic Factors in the Cerebrospinal Fluid of Patients with Astrocytic Brain Tumors

Neurosurgery ◽  
2004 ◽  
Vol 55 (3) ◽  
pp. 562-568 ◽  
Author(s):  
Einat Peles ◽  
Zvi Lidar ◽  
Amos J. Simon ◽  
Rachel Grossman ◽  
Dvora Nass ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Growth Factor ◽  
Brain Tumors ◽  
Tumor Grade ◽  
Angiogenic Factors ◽  
Enzyme Linked Immunosorbent Assay ◽  
Low Grade ◽  
High Grade ◽  
Tumor Vascularity ◽  
Csf Levels

Abstract OBJECTIVE: Gliomas account for most primary brain tumors in adults, and survival correlates with the grade and vascularity of the tumor. The degree of tumor-related angiogenesis seems to be a significant predictor of tumor progression, recurrence, and metastatic spread in a variety of malignant diseases, including brain tumors. Our study's objective was to quantify the levels of two angiogenic factors, basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF), in the cerebrospinal fluid (CSF) and serum of patients with gliomas and to correlate these levels with tumor grade, vascularity, and overall survival. METHODS: Twenty-six patients with the diagnosis of cerebral glioma (19 high-grade, 7 low-grade) comprised the study group. Ten patients with communicating hydrocephalus served as controls. Levels of VEGF and bFGF in the CSF and serum were determined using enzyme-linked immunosorbent assay analysis. Tumor vascularity was graded qualitatively using immunohistochemical staining for CD34. Nonparametric statistical techniques were used for data analysis. RESULTS: Median levels of bFGF and VEGF in the CSF were significantly higher in patients with high-grade glioma as compared with patients with low-grade glioma or hydrocephalus (bFGF levels, 52, 26, and 24 ng/ml, respectively, P &lt; 0.0001; VEGF levels, 17.6, 7.2, and 8.3 ng/ml, respectively, P &lt; 0.005). A significant correlation was found comparing CSF levels of bFGF with levels of VEGF (P &lt; 0.001). The levels of the angiogenic factors in the CSF correlated with the degree of tumor vascularity and were adversely associated with patient survival. Serum levels of the angiogenic factors showed no correlation to tumor grade, vascularity, or survival. CONCLUSION: Our data suggest that CSF levels of bFGF and VEGF may serve as an additional marker for tumor grading and vascularity and may help predict survival.

Cranial Ultrasound in Preterm Neonates of Gestational Age 28 to 34 Weeks: A Single Centre Experience From Western India

2021 ◽  
Vol 35 (3) ◽  
pp. 116-121
Author(s):  
Charul Mehta ◽  
Urvashi Rana
Keyword(s):  
Intraventricular Hemorrhage ◽  
Brain Injuries ◽  
Periventricular Leukomalacia ◽  
Preterm Neonates ◽  
P Value ◽  
Western India ◽  
Cranial Ultrasound ◽  
Normal Variants ◽  
Cavum Septum Pellucidum

Context: Intraventricular hemorrhage and periventricular leukomalacia, the common brain injuries in premature infants, are major causes for early death in the neonatal period and later motor and cognitive disabilities. This study was undertaken to find out the incidence of normal cranial ultrasound (CUS), normal variants, and abnormal CUS findings. Evidence Acquisition: This prospective, observational study was conducted at Neonatal ICU, Department of Paediatrics, Civil Hospital, Ahmedabad, over a period of 2 years from September 1, 2014, to August 31, 2016. Detailed history, examination, and risk factor assessment was done for all 180 subjects. The neonates were subjected to cranial ultrasound during admission and on follow-up. Results: Upon sonographic evaluation, 125 (69.44%) neonates had normal ultrasound, 34 (18.90%) had normal variants, and 21 (11.66%) had abnormal cranial ultrasound findings. The predominant normal variants observed were cavum septum pellucidum (18; 10%) and choroid plexus cyst (11; 6.1%). The most common abnormality detected was intraventricular hemorrhage (15; 8.3%) and was found to have a clinically significant correlation with surfactant use and with mechanical ventilation ( P value < .05). Follow-up scans could be performed on 70 subjects out of which 2 had normal variants and 3 had abnormal CUS findings. Conclusion: Establishing institutional CUS scanning protocols will go a long way in decreasing morbidity and mortality in preterm neonates.

scholarly journals Biochemical Profile of Human Infant Cerebrospinal Fluid in Intraventricular Hemorrhage and Post-hemorrhagic Hydrocephalus of Prematurity

2021 ◽  
Author(s):  
Ayodamola Otun ◽  
Diego Morales ◽  
Maria Garcia-Bonilla ◽  
Seth Goldberg ◽  
Leandro Castaneyra-Ruiz ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Total Protein ◽  
Intraventricular Hemorrhage ◽  
Ventricular Zone ◽  
Human Infant ◽  
Low Grade ◽  
Serum Electrolyte ◽  
Sodium Potassium ◽  
Cell Counts ◽  
Control Serum

Abstract BACKGROUND Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) have complex pathophysiology involving inflammatory response, ventricular zone and cell-cell junction disruption, and choroid-plexus (ChP) hypersecretion. Increased cerebrospinal fluid (CSF) cytokines, extracellular matrix proteins, and blood metabolites have been noted in IVH/PHH, but osmolality and electrolyte disturbances have not been evaluated in human infants with these conditions. We hypothesized that CSF total protein, osmolality, electrolytes, and immune cells increase in PHH. METHODS CSF samples were obtained from lumbar punctures in control infants and infants with IVH prior to development of PHH and any neurosurgical intervention. Osmolality, total protein, and electrolytes were measured in 52 infants (18 controls, 10 low grade (LG) IVH, 13 high grade (HG) IVH, and 11 PHH). Serum electrolyte concentrations, and CSF and serum cell counts within 1-day of clinical sampling were obtained from clinical charts. Dunn or Tukey’s post-test ANOVA analysis were used for pair-wise comparisons. RESULTS CSF osmolality, sodium, potassium, and chloride were elevated in PHH compared to control (p=0.012 - <0.0001), LGIVH (p=0.023 - <0.0001), and HGIVH (p=0.015 - 0.0003), while magnesium and calcium levels were higher compared to control (p=0.031) and LGIVH (p=0.041). CSF total protein was higher in both HGIVH and PHH compared to control (p=0.0009 and 0.0006 respectively) and LGIVH (p=0.034 and 0.028 respectively). These differences were not reflected in serum electrolyte concentrations nor calculated osmolality across the groups. However, quantitatively, CSF sodium and chloride contributed 86% of CSF osmolality change between control and PHH; and CSF osmolality positively correlated with CSF sodium (r,p=0.55,0.0015), potassium (r,p=0.51,0.0041), chloride (r,p=0.60,0.0004), but not total protein across the entire patient cohort. CSF total cells (p=0.012), total nucleated cells (p=0.0005), and percent monocyte (p=0.016) were elevated in PHH compared to control. Serum white blood cell count increased in PHH compared to control (p=0.042) but there were no differences in serum cell differential across groups. CSF total nucleated cells also positively correlated with CSF osmolality, sodium, potassium, and total protein (p=0.025-0.0008) in the whole cohort. CONCLUSIONS CSF osmolality increased in PHH, largely driven by electrolyte changes rather than protein levels. However, serum electrolytes levels were unchanged across groups. CSF osmolality and electrolyte changes were correlated with CSF total nucleated cells which were also increased in PHH, further suggesting PHH is a neuro-inflammatory condition.

Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000–2010

2016 ◽  
Vol 17 (3) ◽  
pp. 260-269 ◽  
Author(s):  
Eisha A. Christian ◽  
Diana L. Jin ◽  
Frank Attenello ◽  
Timothy Wen ◽  
Steven Cen ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Preterm Infants ◽  
Hospital Cost ◽  
Intraventricular Hemorrhage ◽  
Preterm Births ◽  
The United States ◽  
Preterm Neonates ◽  
Average Hospital ◽  
Posthemorrhagic Hydrocephalus ◽  
Congenital Cardiac Anomalies

OBJECT Even with improved prenatal and neonatal care, intraventricular hemorrhage (IVH) occurs in approximately 25%–30% of preterm infants, with a subset of these patients developing hydrocephalus. This study was undertaken to describe current trends in hospitalization of preterm infants with posthemorrhagic hydrocephalus (PHH) using the Nationwide Inpatient Sample (NIS) and the Kids’ Inpatient Database (KID). METHODS The KID and NIS were combined to generate data for the years 2000–2010. All neonatal discharges with ICD-9-CM codes for preterm birth with IVH alone or with IVH and hydrocephalus were included. RESULTS There were 147,823 preterm neonates with IVH, and 9% of this group developed hydrocephalus during the same admission. Of patients with Grade 3 and 4 IVH, 25% and 28%, respectively, developed hydrocephalus in comparison with 1% and 4% of patients with Grade 1 and 2 IVH, respectively. Thirty-eight percent of patients with PHH had permanent ventricular shunts inserted. Mortality rates were 4%, 10%, 18%, and 40%, respectively, for Grade 1, 2, 3, and 4 IVH during initial hospitalization. Length of stay has been trending upward for both groups of IVH (49 days in 2000, 56 days in 2010) and PHH (59 days in 2000, 70 days in 2010). The average hospital cost per patient (adjusted for inflation) has also increased, from $201,578 to $353,554 (for IVH) and $260,077 to $495,697 (for PHH) over 11 years. CONCLUSIONS The number of neonates admitted with IVH has increased despite a decrease in the number of preterm births. Rates of hydrocephalus and mortality correlated closely with IVH grade. The incidence of hydrocephalus in preterm infants with IVH remained stable between 8% and 10%. Over an 11-year period, there was a progressive increase in hospital cost and length of stay for preterm neonates with IVH and PHH that may be explained by a concurrent increase in the proportion of patients with congenital cardiac anomalies.

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