Risk factors associated with post-hemorrhagic hydrocephalus among very low birth weight infants of 24–28 weeks gestation

Objective:post-hemorrhagic hydrocephalus (phh) is associated with morbidity and mortality among very low birth weight (vlbw) infants. this study aimed to determine risk factors for phh among vlbw infants with peri-intraventricular hemorrhage (pivh).study design:this is a population-based cohort of vlbw infants of 24 to 28 weeks gestation, born in israel from 1995 to 2012. infants in whom a brain ultrasound was not performed before 28 days or with major congenital malformations were excluded. univariate and multivariable analyses identified risk factors associated with phh.results:the final study cohort comprised 2811 infants with grade 2 or higher pivh, of whom 610 (21.7%) developed phh. phh was independently associated with pivh severity, with bilateral grade 3 pivh and pivh grade 3 and contralateral grade 4 having the highest risks (odds ratio (or) 12.2, 95% confidence interval (ci) 8.56 to 17.4 and or 13.7, 95% ci 9.4 to 20.1, respectively). unilateral grade 3 or 4 pivh's had moderately increased risks of phh (or 3.50, 95% ci 2.26 to 5.42 and or 3.79, 95% ci 2.35 to 6.12, respectively). phh was independently associated with increasing gestational age (ga) and with neonatal morbidities including patent ductus arteriosus (or 1.47, 95% ci 1.15 to 1.88 if medically treated and or 3.01, 95% ci 2.11 to 4.29 if surgically treated), sepsis (or 1.79, 95% ci 1.44 to 2.22) and necrotizing enterocolitis (or 1.60, 95% ci 1.18 to 2.17).conclusions:among vlbw infants with pivh, phh was independently associated with pivh severity group, increasing ga and acute neonatal morbidities. unilateral grade 3 or 4 pivh was associated with a moderate risk of developing phh compared with bilateral severe hemorrhages.