Management strategy for intraventricular hemorrhage complicated by posthemorrhagic hydrocephalus in preterm newborns

Introduction. Intraventricular hemorrhage (IVH) in preterm newborns remains one of the leading causes of adverse neurological outcomes and is frequently complicated by the development of posthemorrhagic hydrocephalus (PHH), which requires staged neurosurgical treatment. The optimal management strategy for this category of patients remains under discussion, particularly in the context of increasing survival rates among extremely preterm infants.

Aim. To evaluate the clinical course of IVH, the incidence of posthemorrhagic hydrocephalus, and the effectiveness of a staged management strategy in preterm newborns.

Materials and methods. A retrospective-prospective study included 32 preterm newborns with IVH treated at the National Center for Maternal and Child Health (Kyrgyzstan) between 2020 and 2025. Diagnostic evaluation included serial cranial ultrasonography, MRI when indicated, assessment of ventricular indices (VI, AHW, TOD), and cerebral hemodynamics. Treatment strategy was based on the progression of ventriculomegaly and the clinical condition of patients. Management included dynamic observation, temporary cerebrospinal fluid (CSF) diversion procedures, and ventriculoperitoneal shunting.

Results and discussion. Severe IVH (grades III–IV) was identified in 75.1% of patients. Posthemorrhagic hydrocephalus developed in 57.1% of grade III cases and 80.0% of grade IV cases. Temporary CSF diversion methods were used in 34.4% of patients, while ventriculoperitoneal shunting was performed in 40.6%. The frequency of shunt placement was significantly higher in severe IVH (grades III–IV) (p = 0.02). Mortality was 12.5% and was primarily associated with grade IV IVH. The staged management algorithm enabled stabilization of many patients and supported optimal timing of surgical intervention.

Conclusions. The risk of posthemorrhagic hydrocephalus is directly associated with the severity of intraventricular hemorrhage. A staged management strategy involving dynamic neurosonographic monitoring and sequential use of temporary CSF diversion with subsequent transition to permanent shunting is an effective approach for managing preterm newborns with IVH complicated by PHH.

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