6714 Outcomes of antenatal ventriculomegaly and postnatally acquired neonatal hydrocephalus – a 5-year retrospective study at a tertiary neonatal unit

Objectives To analyse interventions and outcomes of neonates with antenatal ventriculomegaly and postnatally acquired hydrocephalus over a period of 5 years in a tertiary neonatal unit. Methods We collected retrospective data on all neonates who were diagnosed to have ventriculomegaly either antenatally or postnatally over a 5-year period (Jan 2017 to Dec 2022) from national neonatal database (Badger). This included baseline characteristics, grade of intra-ventricular haemorrhage (IVH) based on the Papile classification,¹ postnatal age of IVH, maximum ventricular indices (VI), the need for initial interventions, initial neuro-surgical interventions (subgaleal shunts or reservoirs) and subsequent insertion of ventriculo-peritoneal (VP) shunts. Results In total, 59 babies had either antenatally (n=20) or postnatally diagnosed ventriculomegaly (n=39). Of the 20 babies with antenatal ventriculomegaly, 2 had VP shunts inserted and survived. Out of the remaining 18 babies, 16 were discharged home and 2 died before hospital discharge. The deaths were associated with genetic conditions. Post-haemorrhagic ventricular dilatation (PHVD) was the most common cause of hydrocephalus, with 22 of the 39 babies (56%) having either grade 3 or 4 IVH. 51% of the babies (20/39) had VI above the 97th centile + 4mm, which is the consensus threshold for neurosurgical intervention.²2 babies died and the remaining 18 had attempts of therapeutic lumbar punctures to reduce intracerebral pressures. 15 of these babies had neurosurgical interventions such as subgaleal shunt (10), Omaya reservoir (2), ventricular access device (VAD) (1) and VP shunt (2). VP shunts were directly placed in babies who were term corrected gestation(2). 8 out of 10 babies (80%) who had initial subgaleal shunt had complications with blocked shunts and required insertion of VP shunts. Babies who initially had Omaya reservoirs and VAD needed VP shunt subsequently. Other complications of surgical interventions included 1 blocked VP, 2 leaked subgaleal shunts and 1 post subgaleal shunt hemorrhage. In terms of outcome, 6 out of 39 babies (15%) who had PHVD and 2 out of 20 babies (10%) with antenatal ventriculomegaly died. Conclusion Two thirds of neonatal ventriculomegaly are postnatally acquired following IVH (mostly grade 3 or 4 IVH, although can also result from grade 1–2 IVH). Almost half of PHVD required neurosurgical intervention initially with temporary measures and for definitive treatment with VP shunt.³ Almost all the babies who had a reservoir placed ended up having VP shunt. Antenatal ventriculomegaly required far less intervention and had better outcomes as compared to PHVD.⁴ References Papile L-A, et al. 'Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm', The Journal of Pediatrics 1978;92(4):529–534. doi:10.1016/s0022-3476(78)80282-0. Levene MI 'Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound.', Archives of Disease in Childhood 1981;56(12):900–904. doi:10.1136/adc.56.12.900. Whitelaw A, Aquilina K 'Management of posthaemorrhagic ventricular dilatation', Archives of Disease in Childhood – Fetal and Neonatal Edition 2011;97(3). doi:10.1136/adc.2010.190173. Gaglioti P, et al. 'Fetal cerebral ventriculomegaly: Outcome in 176 cases', Ultrasound in Obstetrics & Gynecology 2005;25(4):372–377. doi:10.1002/uog.1857.