Antenatal Post-hemorrhagic Ventriculomegaly: A Prospective Follow-up Study

Abstract

Objective: The aim of this study was to evaluate the presence and the severity of neurological and cognitive impairment at 2 years of age in 16 infants (9 term born, 7 preterm of mean gestation 33.6 weeks) with cerebral ventriculomegaly of antenatal onset associated with intraventricular haemorrhage.

Methods: Ventricular dilatation, with or without associated lesions, was, with one exception, not identified on the antenatal routine scan at approximately 22 weeks but was obvious on the scans performed between weeks 27 and 33. In 8 of the 16 cases there were signs of parenchymal involvement or of abnormalities of the corpus callosum or cerebellum. In all patients the diagnosis of antenatal IVH was confirmed by early neonatal imaging. Outcome was measured using the Hammersmith infant neurological examination and the Griffiths developmental scales at 2 years.

Results and Conclusions: At 2 years, 8 infants had normal motor outcome and 8 had cerebral palsy. The presence and severity of cerebral palsy or neurodevelopmental delay was not always related to the magnitude or symmetry of the ventricular dilatation per se. The presence of associated lesions was a negative prognostic marker. The early development of epilepsy was also associated with an abnormal outcome.

Key words

Ventriculomegaly - post-haemorrhagic status - antenatal status - outcome

References

• 1 Cardoza JD, Goldstein RB, Filly RA. Exclusion of fetal ventriculomegaly with a single measurement: the width of the lateral ventricular atrium.  Radiology. 1988;  169 711-714
• 2 de Vries LS, Eken P, Groenendaal F, Rademaker KJ, Hoogervorst B, Bruinse HW. Antenatal onset of haemorrhagic and/or ischaemic lesions in preterm infants: prevalence and associated obstetric variables.  Arch Dis Child Fetal Neonatal Ed. 1998;  78 F51-56
• 3 de Vries LS, Haastert IL Van, Rademaker KJ, Koopman C, Groenendaal F. Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants.  J Pediatr. 2004;  144 815-820
• 4 Elchalal U, Yagel S, Gomori JM, Porat S, Beni-Adani L, Yanai N. et al . Fetal intracranial hemorrhage (fetal stroke): does grade matter?.  Ultrasound Obstet Gynecol. 2005;  26 233-243
• 5 Ghi T, Simonazzi G, Perolo A, Colleoni GG, Pilu G, Bovicelli L. Outcome of antenatally diagnosed intracranial hemorrhage: case series and review of the literature.  Ultrasound Obstet Gynecol. 2003;  22 121-130
• 6 Himmelmann K, Hagberg G, Beckung E, Hagberg B, Uvebrant P. The changing panorama of cerebral palsy in Sweden. IX. Prevalence and origin in the birth-year period 1995-1998.  Acta Paediatr. 2005;  94 287-294
• 7 Hope PL, Gould SJ, Howard S, Hamilton PA, Costello AM, Reynolds EO. Precision of ultrasound diagnosis of pathologically verified lesions in the brains of very preterm infants.  Dev Med Child Neurol. 1988;  30 457-471
• 8 Huntley M. The Griffiths Mental Development Scales: from birth to 2 years.  , Association for Research in Infant and Child Development (ARICD), 1996; 
• 9 Levene MI. Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound.  Arch Dis Child. 1981;  56 900-904
• 10 Levine D, Barners PD, Madsen JR, Abbott J, Mehta T, Edelman RR. Central nervous system abnormalities assessed with prenatal magnetic resonance imaging.  Obstet Gynecol. 1999;  94 1011-1019
• 11 Masini L, Santis M De, Noia G, Ciotti S, Caldarelli M, Rocco C Di. et al . Fetal ventriculomegaly: prenatal diagnosis and counselling.  Ultrasound Obstet Gynecol. 2003;  22 ((Suppl 1)) 21
• 12 Özduman K, Pober BR, Barnes P, Copel J, Ogle EA, Duncan CC. et al . Fetal stroke.  Pediatr Neurol. 2004;  30 151-162
• 13 Parazzini F, Cortinovis I, Bortolus R, Fedele L. Standards of birth weight in Italy.  Ann Ostet Ginecol Med Perinat. 1991;  112 203-246
• 14 Reiss I, Gortner L, Moller J, Gehl HB, Baschat AA, Gembruch U. Fetal intracerebral hemorrhage in the second trimester: diagnosis by sonography and magnetic resonance imaging.  Ultrasound Obstet Gynecol. 1996;  7 49-51
• 15 Ricci D, Luciano R, Baranello G, Veredice C, Cesarini L, Bianco F, Pane M, Gallini F, Vasco G, Savarese I, Zuppa A, Masini L, Rocco C Di, Romagnoli C, Guzzetta F, Maercuri E. Visual development in prenatal post-haemorrhagic ventricular dilatation.  Arch Dis Child Fetal Neonatal Ed. 2007;  22 F255-258
• 16 Sherer DM, Anyaegbunam A, Onyeije C. Antepartum fetal intracranial hemorrhage, predisposing factors and antenatal sonography: a review.  Am J Perinatol. 1998;  15 431-441
• 17 Gelder-Hasker MR Van, Wezel-Meijler G van, Groot L de, Geijn HP van, Vries JI de. Peri and intraventricular cerebral sonography in second and third trimester high risk fetuses: a comparison with neonatal ultrasound and relation to neurological development.  Ultrasound Obstet Gynecol. 2003;  22 110-120
• 18 Vergani P, Strobelt N, Locatelli A, Paterlini G, Tagliabue P, Parravicini E. et al . Clinical significance of fetal intracranial hemorrhage.  Am J Obstet Gynecol. 1996;  175 ((3 Pt 1)) 536-543
• 19 Vollmer B, Roth S, Riley K, Sellwood MW, Baudin J, Neville BG. et al . Neurodevelopmental outcome of preterm infants with ventricular dilatation with and without associated haemorrhage.  Dev Med Child Neurol. 2006;  48 348-352

Correspondence