Observed pre-intervention and non-intervention ventricular growth trajectories in neonates with severe intraventricular hemorrhage and post-hemorrhagic ventricular dilation

Background Post-hemorrhagic ventricular dilation (PHVD) after severe intraventricular hemorrhage (SIVH) remains incompletely characterized. Objective To quantify ventricular expansion after SIVH and explore associations with bilateral hemorrhage burden and mortality. Methods We retrospectively reviewed 43 neonates with SIVH-associated PHVD cared for in a single NICU from 2010 to 2025. Serial cranial ultrasounds were measured for ventricular index (VI) and anterior horn width (AHW). Post-intervention measurements were censored. An exploratory bilateral hemorrhage-burden score summed maximum right and left IVH grades. Results VI and AHW increased significantly with PMA, each at 0.105 mm/day. High composite IVH score (7–8) was associated with faster VI and AHW expansion than low score (3–6), and with higher mortality. Conclusions Ventricular enlargement progressed approximately linearly during observed pre-intervention/non-intervention follow-up. Bilateral hemorrhage-burden scoring may improve risk stratification, but findings are exploratory.