Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts.
Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts.
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DOI：
10.3171/2011.12.peds11136
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发表时间：
2012-03
期刊：
影响因子：
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通讯作者：
Robinson S
中科院分区：
文献类型：
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作者：
Robinson S
早产儿有发生围产期并发症的风险，包括生发基质-脑室出血(IVH)和随后的出血性脑积水(PHH)。本文综述了目前对早产儿IVH和PHH的流行病学、病理生理学、治疗和结局的认识。使用与IVH、PHH和相关神经外科手术相关的术语系统地搜索MEDLINE数据库，以确定英文医学文献中的出版物。为了补充系统搜索的信息，从最初搜索中确定的文章的参考文献中选择了相关文章。本文主要采用循证研究的方法，对IVH和PHH的流行病学和病理生理学的研究现状进行综述。在过去的几十年里，产科和新生儿学的进步显著提高了早产儿的存活率，神经系统的发病率也开始下降。IVH的发病率正在下降，PHH的发病率可能会随之下降。目前，大约15%遭受严重IVH的早产儿将需要永久的脑脊液分流。本文讨论了症状性PHH的临床表现和外科治疗。患有需要手术治疗的PHH的早产儿仍然处于其他相关神经问题的高危状态，包括脑瘫、癫痫以及认知和行为延迟。这项审查强调了许多进一步研究的机会，以改善对这些儿童的照顾。更好地掌握IVH的病理生理学开始影响IVH和PHH的发生率。新生儿科医生进行严格的I级和II级研究，以改善早产儿的结局。由于IVH和PHH发生率的下降，转诊模式的变化，以及新生儿ICU和神经外科治疗，设计良好的多中心试验是至关重要的。精心设计的多中心试验最终将产生证据，使神经外科医生能够为他们最小、最脆弱的患者提供最佳实践，将围手术期并发症和永久性分流依赖降至最低，最重要的是，优化长期神经发育结果。(http://thejns.org/doi/abs/10.3171/2011.12.PEDS11136)
Preterm infants are at risk for perinatal complications, including germinal matrix–intraventricular hemorrhage (IVH) and subsequent posthemorrhagic hydrocephalus (PHH). This review summarizes the current understanding of the epidemiology, pathophysiology, management, and outcomes of IVH and PHH in preterm infants. The MEDLINE database was systematically searched using terms related to IVH, PHH, and relevant neurosurgical procedures to identify publications in the English medical literature. To complement information from the systematic search, pertinent articles were selected from the references of articles identifed in the initial search. This review summarizes the current knowledge regarding the epidemiology and pathophysiology of IVH and PHH, primarily using evidence-based studies. Advances in obstetrics and neonatology over the past few decades have contributed to a marked improvement in the survival of preterm infants, and neurological morbidity is also starting to decrease. The incidence of IVH is declining, and the incidence of PHH will likely follow. Currently, approximately 15% of preterm infants who suffer severe IVH will require permanent CSF diversion. The clinical presentation and surgical management of symptomatic PHH with temporary ventricular reservoirs (ventricular access devices) and ventriculosubgaleal shunts and permanent ventriculoperitoneal shunts are discussed. Preterm infants who develop PHH that requires surgical treatment remain at high risk for other related neurological problems, including cerebral palsy, epilepsy, and cognitive and behavioral delay. This review highlights numerous opportunities for further study to improve the care of these children. A better grasp of the pathophysiology of IVH is beginning to impact the incidence of IVH and PHH. Neonatologists conduct rigorous Class I and II studies to advance the outcomes of preterm infants. The need for well-designed multicenter trials is essential because of the declining incidence of IVH and PHH, variations in referral patterns, and neonatal ICU and neurosurgical management. Well-designed multicenter trials will eventually produce evidence to enable neurosurgeons to provide their smallest, most vulnerable patients with the best practices to minimize perioperative complications and permanent shunt dependence, and most importantly, optimize long-term neurodevelopmental outcomes. (http://thejns.org/doi/abs/10.3171/2011.12.PEDS11136)