Treatment thresholds for intervention in posthaemorrhagic ventricular dilation: a randomised controlled trial

Linda S de Vries, Floris Groenendaal, Kian D Liem, Axel Heep, Annemieke J Brouwer, Ellen van 't Verlaat, Isabel Benavente-Fernández, Henrica Lm van Straaten, Gerda van Wezel-Meijler, Bert J Smit, Paul Govaert, Peter A Woerdeman, Andrew Whitelaw,

Research output: Contribution to journalArticleAcademicpeer-review


Objective To compare a low versus a higher threshold for intervention in preterm infants with posthaemorrhagic ventricular dilatation. Design Multicentre randomised controlled trial (ISRCTN43171322). Setting 14 neonatal intensive care units in six countries. Patients 126 preterm infants ≤34 weeks gestation with ventricular dilatation after grade III-IV haemorrhage were randomised to low threshold (LT) (ventricular index (VI) >p97 and anterior horn width (AHW) >6 mm) or higher threshold (HT) (VI>p97+4 mm and AHW >10 mm). Intervention Cerebrospinal fluid tapping by lumbar punctures (LPs) (max 3), followed by taps from a ventricular reservoir, to reduce VI, and eventually a ventriculoperitoneal (VP) shunt if stabilisation of the VI below the p97+4 mm did not occur. Composite main outcome measure VP shunt or death. Results 19 of 64 (30%) LT infants and 23 of 62 (37%) HT infants were shunted or died (P=0.45). A VP shunt was inserted in 12/64 (19%) in the LT and 14/62 (23%) infants in the HT group. 7/12 (58%) LT infants and 1/14 (7%) HT infants required shunt revision (P<0.01). 62 of 64 (97%) LT infants and 36 of 62 (58%) HT infants had LPs (P<0.001). Reservoirs were inserted in 40 of 64 (62%) LT infants and 27 of 62 (43%) HT infants (P<0.05). Conclusions There was no significant difference in the primary composite outcome of VP shunt placement or death in infants with posthaemorrhagic ventricular dilatation who were treated at a lower versus a higher threshold for intervention. Infants treated at the lower threshold received more invasive procedures. Assessment of neurodevelopmental outcomes will provide further important information in assessing the risks and benefits of the two treatment approaches.

Original languageEnglish
Pages (from-to)F70-F75
JournalArchives of Disease in Childhood Fetal and Neonatal Edition
Issue number1
Early online date10 Feb 2018
Publication statusPublished - Jan 2019


  • neonatology
  • preterm
  • intraventricular haemorrhage
  • imaging
  • post haemorrhagic ventricular dilatation
  • Severity of Illness Index
  • Cerebral Hemorrhage/surgery
  • Infant, Premature, Diseases/surgery
  • Spinal Puncture
  • Humans
  • Male
  • Cerebrovascular Circulation
  • Gestational Age
  • Portasystemic Shunt, Surgical/methods
  • Intensive Care Units, Neonatal
  • Cerebral Ventricles/surgery
  • Infant, Premature
  • Female
  • Dilatation, Pathologic
  • Infant, Newborn


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