What is post-hemorrhagic ventricular dilation?
Post-hemorrhagic ventricular dilatation (PHVD) is a condition that occurs when the fluid spaces in a newborn’s brain increase in size due to bleeding. This bleeding happens in a part of the brain that is still developing and making new brain cells. It is more likely to happen in very young babies, especially premature infants born before 32 weeks of pregnancy.
The bleeding can happen for different reasons, including:
- if the baby’s blood vessels are very delicate
- if there’s a sudden change in a baby’s blood pressure
- if the baby’s brain is not getting enough oxygen or blood
The bleeding is called an intraventricular hemorrhage. Serious bleeding can block the flow of the brain fluid, causing these spaces to get bigger, which is what PHVD is.
Signs and symptoms of PVHD
Babies with PVHD may not have any symptoms. They may be diagnosed with PVHD based on the results of a brain ultrasound that is done to monitor premature babies.
Other premature babies with PVHD may have:
- apnea (pause in breathing) or bradycardia (a drop in heart rate)
- increased sleepiness or irritability
- vomiting
- poor feeding
- an increase in the measurement of their head circumference
- a bulging fontanelle (the soft spot at the top of their head)
What types of testing do babies with PHVD undergo?
To fully understand the effect of the enlarged fluid spaces on your baby’s brain and to monitor your baby’s progress, their health-care team will perform a series of tests. These tests help the team assess your baby’s condition and plan the best course of action. They include:
- Blood work: Regular blood tests help monitor a baby’s metabolic balance and assess organ function.
- Brain ultrasound: A brain ultrasound can show the structure of the baby’s brain and help the health-care team detect any major abnormalities.
- Brain MRI: A brain MRI provides more detailed images of the brain and helps the health-care team assess the extent and location of any injury. The MRI gives the team the most accurate picture of a baby’s brain health and helps them to plan ongoing care and interventions.
What are the treatments for PHVD?
Babies with PHVD are admitted to the neonatal intensive care unit (NICU) for specialized care and monitoring. If a baby needs to have pressure on the brain relieved by removing excess fluid, the first procedure that is usually performed is a lumbar puncture. Some babies with PHVD will need a ventricular access device for ongoing fluid drainage. In some cases, a ventriculoperitoneal shunt may be necessary to divert fluid away from the brain to another part of the body.
Lumbar puncture (spinal tap): A lumbar puncture, often called a spinal tap, is a procedure where a needle is gently inserted into the lower part of the spine to remove a small amount of cerebrospinal fluid. This fluid surrounds the brain and spinal cord. Removing some fluid can relieve the pressure on a baby’s brain if it is too high. The procedure is done with care to ensure a baby is comfortable and safe.
Ventricular access devices: If a baby needs ongoing management of fluid in the brain, a ventricular access device, such as a reservoir, may be placed. This is a small, soft tube that goes into the ventricles, which are fluid-filled spaces in the brain. The device allows the health-care team to remove fluid regularly without needing to do repeated lumbar punctures. It is a temporary measure that can be helpful for managing fluid levels.
Ventriculoperitoneal shunt (VP shunt): In some cases, if a baby has a long-term need for fluid drainage, a ventriculoperitoneal shunt might be necessary. This is a more permanent solution where a flexible tube is placed into the fluid-filled space in the brain. The other end of the tube is moved under the skin to another part of the body, usually the abdomen, where the fluid can be absorbed. This shunt helps to continuously divert fluid from the brain to reduce pressure and prevent damage.
These interventions help prevent further brain injury by managing the pressure and fluid levels within the brain. They are performed by a team of skilled neurosurgeons and NICU staff who specialize in the care of newborns. They use the latest techniques and equipment to ensure the highest standards of safety and comfort for your baby. Each step is taken with the utmost care, and parents are kept informed throughout the process. The goal is to protect the baby’s brain and give them the best possible start in life.
Ongoing monitoring
Your baby will continue to have brain ultrasound scans and brain MRIs in order to assess the extent of brain injury. These scans provide the health-care team with detailed images that help them tailor treatment plans to your baby. These imaging tools also allow the health-care team to predict potential developmental outcomes and challenges a baby may face. Predicting outcomes sooner allows the health-care team to begin necessary interventions promptly, taking advantage of the baby’s brain adaptability, known as neuroplasticity. This can lead to better long-term outcomes for each child. In addition to these tests, the health-care team conducts standardized neurological examinations on a regular basis to monitor each baby.
Next steps and long-term follow-up
After your baby is discharged from the NICU, it is very important to return for check-ups in the neonatal neurodevelopmental follow-up clinic to keep track of your baby's growth and development. During each visit, the health-care team will carefully check your baby's progress, including their growth, movements and if they are learning new things. If any issues or delays in a baby's development are identified, the health-care team can step in early with special therapies or treatments as early help can make a big difference. The clinic offers support and resources for babies and their families to help navigate this journey.
If needed, some babies will be referred to a neurologist for extra care. Keeping up with these follow-up visits over the long term is very important, as it helps the health-care team ensure each child gets the best care and support as they continue to grow.
At SickKids
Our dedicated team
At SickKids, every baby is cared for by a large team of dedicated experts from various disciplines. This includes neonatologists, neurologists, nurses, respiratory therapists, occupational and physical therapists, social workers and other specialists. Each member of the team plays a critical role in each baby’s care, bringing their expertise and compassion to support your family during this challenging time. They work closely together to provide comprehensive, coordinated care that addresses all aspects of every baby’s health and development.