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Implementation of an early intervention strategy for post hemorrhagic ventricular dilatation in preterm infants

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Objective

Evaluate earlier intervention on short- and longer-term outcomes in preterm infants with post-hemorrhagic ventricular dilatation (PHVD) born at ≤32 weeks’ gestation.

Study design

Retrospective, multi-center, observational study.

Results:

One hundred patients met eligibility criteria. Of 70 survivors, PHVD resolved spontaneously in 32 (46%). The 38 infants needing intervention were managed with: lumbar puncture (LP) alone (n = 23, 60%); LP and ventricular access device (VAD) only (n = 6, 16%); LP, VAD, ventricular-peritoneal shunt (n = 9, 24%). There were no differences in incidence of cerebral palsy or Bayley Scales of Infant and Toddler Development (BSID-III) composite score between the intervention and non-intervention group (p > 0.5). Neurosurgical intervention was initiated at smaller ventricle size and BSID-III scores improved significantly compared to a historical cohort with late intervention, (p < 0.05).

Conclusion

Initiation of early intervention for PHVD was feasible and was associated with improved neurodevelopmental outcomes compared to late intervention.

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Fig. 1: Early intervention protocol.
Fig. 2: All infants in earlier intervention cohort.
Fig. 3: BSID-III composite scores for survivors without and with intervention in historical late cohort and early cohort.

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Data availability

The datasets and materials used or analysed during this study are available from the corresponding author on request.

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Acknowledgements

We thank the Neonatal Nurse Practitioners in the NICU at the Hospital for Sick Children for their meticulous ongoing care of many fragile patients with VAD who require daily reservoir taps, often for many months. We are grateful to the Neonatal Neurodevelopmental Follow Up teams at SickKids, Mount Sinai and Sunnybrook Hospital for completing BSID-III testing during the global pandemic.

Author information

Authors and Affiliations

  1. Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Diane Wilson, Sara Breitbart, Mehmet Cizmeci, Rosanna Pais, Jeffery Traubici, Abhaya V. Kulkarni & Linh G. Ly

  2. Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

    Lee DiFonzo, Edmond Kelly, Yenge Diambomba, Dilkash Kajal & Kamini Raghuram

  3. Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada

    Sabrina Wong, Eugene Ng, Paige Church, Elizabeth Asztalos & Phyllis Glanc

  4. Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, AB, Canada

    Lara M. Leijser

  5. BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada

    Steven P. Miller

Authors
  1. Diane Wilson
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  2. Sara Breitbart
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  3. Lee DiFonzo
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  10. Paige Church
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  11. Elizabeth Asztalos
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  12. Phyllis Glanc
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  13. Mehmet Cizmeci
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  15. Jeffery Traubici
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  16. Lara M. Leijser
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  19. Linh G. Ly
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Contributions

D.W. designed the protocol, the data collection instrument, collated the data from participating centers, carried out the initial data analysis and drafted the manuscript, reviewed and revised the manuscript. S.B., A.K., L. Leijser, and L.Ly designed the protocol and data collection instrument, critically analyzed the data and aided in the interpretation of the results and reviewed and revised the manuscript. L.D., E.K., K.R., S.W., and E.A. collected data at their participating centers and critically reviewed the manuscript. Y.D., E.N., P.C., and S.M. conceptualized the study, aided in the interpretation of the results and critically reviewed the manuscript. P.G., D.K., and J.T. reviewed the protocol and provided feedback specific to interpretation of cUS findings and critically reviewed the manuscript. M.C. aided in the interpretation of the results and critically reviewed the manuscript. RP assisted with the development of the REDCap data collection tool and assisted with co-ordination of REB approvals.

Corresponding author

Correspondence to Diane Wilson.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Research Ethics Board approval was obtained from Clinical Trials Ontario (Study ID 3226). Parental consent was not obtained as this was considered an evidence-based change in practice. This study was performed in accordance with the Declaration of Helsinki.

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Wilson, D., Breitbart, S., DiFonzo, L. et al. Implementation of an early intervention strategy for post hemorrhagic ventricular dilatation in preterm infants. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02371-5

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