Authors: George William Koutsouras, MPH, MD
Germinal matrix hemorrhage is known to lead to significant morbidity and mortality, including hydrocephalus, cerebral palsy, and death. Determining those who are at risk of developing post hemorrhagic hydrocephalus and requiring an intervention is not clearly known. Understanding this relationship can highlight potentially high-risk groups and help uncover key features in the pathophysiology of post hemorrhagic hydrocephalus.Methods: We describe the prevalence of germinal matrix hemorrhage in the neonatal intensive care unit at a single institution in Central New York. We highlight the prevalence of neurosurgical intervention in this population. Data from 2012 to 2020 was collected and analyzed.
In our population, 642 neonates were diagnosed with a germinal matrix hemorrhage or periventricular leukomalacia. Of this population, 49 patients (7.5%) obtained a neurosurgical consultation, in which 35% (71.4%) required an intervention. The average grade of hemorrhage was 1.7 of the entire cohort was 1.7, compared to the patients who obtained a neurosurgical consultation had a germinal matrix hemorrhage on average of 3.3. A hundred forty-eight patients had grades III or IV hemorrhage (23.1%). Female patients were 47% of the neurosurgical consultations. Those patients with either a grade III or grade IV hemorrhage obtained a neurosurgical consultation 37.3% and 28.1% of the time, respectively. An intervention was required in grade III or grade IV hemorrhage 22.0 and 21.3% of the time, respectively, of which a ventriculoperitoneal shunt was the most common intervention necessary (17.0% and 13.5).
Patients who had a high-grade germinal matrix (III or IV) hemorrhage obtained an intervention 21.6% of the time. Future analysis that aims to decipher those with a germinal matrix hemorrhage that require neurosurgical intervention compared to those that do not and live without the need for cerebrospinal fluid diversion is warranted.