Post Hemorrhagic Hydrocephalus in Infants: Methods of Treatment and Prognostic Factors

Elsayed, Mohamed Ezzat; Mohamed, Samy Hassanien; Mohamed, Saeid Abdel-Latif Osman; Ali, Mohamed M.

doi:10.21608/zumj.2025.371678.3894

Post Hemorrhagic Hydrocephalus in Infants: Methods of Treatment and Prognostic Factors

Document Type : Original Article

Authors

¹ Neurosurgery Department, Faculty of Medicine, Zagazig University, Egypt

² Neurosurgery Department, Faculty of Medicine, Zagazig University

10.21608/zumj.2025.371678.3894

Abstract

Background: The most prevalent yet dangerous neurological condition in infants is posthemorrhagic hydrocephalus (PHH), which can have life-threatening effects during the acute phase of the newborn period and long-lasting psychomotor and cognitive aftereffects in later life. So, we aimed to investigate the prognostic factors for infants with post-hemorrhagic hydrocephalus and assess the therapeutic approaches. Methods: Prospective cohort study included 18 infants with post hemorrhagic hydrocephalus, US and MRI done to all studied participants. Follow up after 12 month post treatment. Results: Among the 18 studied infants, 15 (83.3%) had post-hemorrhagic hydrocephalus (PHH), while 3 (16.7%) developed hydrocephalus due to post-subarachnoid hemorrhage. 33.3% had grade 2 IVH, 16.8% had grade 3 IVH, and 50% had grade 4 IVH. PHH was significantly associated with higher Papile grading and lower gestational age. Multivariate analysis identified ultrasound grade and gestational age as independent risk factors for PHH. Mortality occurred in 55.6% of infants, all with PHH, and increased with higher IVH grades, head circumference >2 SD, and lower gestational age. Risk factors for death included high IVH grade, increased head circumference, and low gestational age. Secondary outcomes at two years included speech delay (22.2%), epilepsy (5.6%), visual deficiency (11.1%), and hearing impairment (5.6%). Conclusion: While post-hemorrhagic hydrocephalus (PHH) with elevated intracranial pressure (ICP) can happen with any grade of IVF, grade III and IV IVF are more likely to cause it. Once ≥ grade II IVH is detected on ultrasound, monitoring head circumference and daily anterior fontanelle palpation can assist detect worsening hydrocephalus.

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