Intraventricular Hemorrhage and Post Hemorrhagic Ventricular Dilation: Natural Course, Treatment, and Outcome
Intraventricular Hemorrhage and Post Hemorrhagic Ventricular Dilation: Natural Course, Treatment, and Outcome
Intraventricular hemorrhage and its resultant post-hemorrhagic hydrocephalus are significant
 risk factors for the development of neurodevelopmental delays in preterm infants. The purpose
 of this study is to determine 1) the incidence of progressive post-hemorrhagic ventricular
 dilatation (PHVD) in infants with severe intraventricular hemorrhage (IVH), 2) the effect of
 ventricular dilatation on brain status (cerebral oxygenation, electrical activity, and
 biomarkers of cerebral damage and repair), and 3) if using ventricular measurements, derived
 from cranial ultrasound to guide removal of cerebral-spinal fluid through an Omaya reservoir,
 will help resolve ventricular dilatation and decrease the need for ventriculo-peritoneal (VP)
 shunt insertion. The hypothesis of this research project is that, by using ventricular
 measurements to guide the frequency of CSF removal, the rate of VP shunt insertion will be
 decreased in preterm infants with severe IVH and PHVD. The investigators further hypothesize
 that cerebral injury, as measured by cerebrospinal fluid (CSF) concentration of biomarkers of
 neuronal and glial damage and inflammation, will decrease over time with resolution of PHVD.
When an infant has severe IVH noted on cranial ultrasound, s(he) will receive weekly
 ultrasounds to evaluate progression of ventricular dilatation (standard of care). After the
 infant is enrolled in this study, Near-Infrared Spectroscopy (NIRS) and Amplitude integrated
 Electroencephalogram (aEEG) will be performed 1-2 times per week. After Omaya reservoir
 insertion, ventricular dimensions, based on weekly (standard of care) cranial ultrasounds,
 will determine frequency of CSF removal. NIRS and aEEG will continue 1-2 times per week to
 coincide with CSF removal. In addition, 1-2 times per week aliquots of CSF will be stored for
 evaluation of biomarkers. We will evaluate the impact of IVH and PHVD over time on cerebral
 oxygenation (NIRS) and cortical electrical activity (aEGG) starting at the time of
 identification of IVH and correlate these measurements to ventricular dimensions. If an Omaya
 reservoir is required to control PHVD, we will use ventricular dimensions to guide the
 frequency of CSF removal and continue to evaluate brain status by measuring cerebral
 oxygenation (NIRS) and cortical electrical activity (aEGG).
Inclusion Criteria:

 -  severe IVH

 -  receiving weekly head ultrasounds for monitoring

 Exclusion Criteria:

 -  no or minimal IVH