Detection and management of posthemorrhagic ventricular dilation (PHVD) in preterm infants*

IVH: intraventricular hemorrhage; VI: ventricular index; PMA: postmenstrual age; LP: lumbar puncture; CSF: cerebrospinal fluid; VAD: ventricular access device.
* This algorithm is based on the evaluation and management approach of the authors on the UpToDate topic on prevention, management, and complications of germinal matrix hemorrhage and intraventricular hemorrhage (GMH-IVH) in the newborn.
¶ Severe IVH is defined as grade III IVH (IVH involving more than 50% of ventricular area and distended lateral ventricles at time of diagnosis) and grade IV IVH (periventricular hemorrhagic infarction).
Δ Ultrasound measurements used to detect ventricular dilation include ventricular index (VI), which is defined as the distance between the falx (double-fold of dura mater that descends through the interhemispheric fissure in the midline of the brain to separate the cerebral hemispheres) and the lateral wall of the anterior horn in the coronal plane at level of the foramen of Monro; anterior horn width (AHW), which is defined as the largest diagonal width of the anterior horn in the coronal plane at the level of the foramen of Monro; thalamo-occipital distance (TOD), which is defined as the distance between the outermost point of the thalamus at its junction with the choroid plexus and the outermost border of the occipital horn in the parasagittal plane; and resistance index of cerebral artery blood flow, which is defined as the difference between peak systolic flow velocity and the end diastolic flow velocity/peak systolic flow velocity.
◊ Serial daily LPs performed to maintain a VI <4 mm above the 97^th percentile for PMA based on daily ultrasound monitoring.
§ Progressive dilation that reaches a VI threshold >4 mm above the 97^th percentile for PMA.
¥ Daily drainage from VAD performed to reduce VI <97^th percentile for PMA within 7 to 10 days of VAD placement. CSF is removed by performing 1 or 2 taps per day.
‡ Criteria for placement of VP shunt are patient weight >2 kg and CSF protein <1.5 g/L and red blood cell count <100 mm³.