Clinical significance of ventriculomegaly in children who suffered perinatal asphyxia with or without intracranial hemorrhage: an 18 month follow-up study.

One-hundred and thirty neonates who suffered perinatal asphyxia were divided into two groups according to maturity at birth. All the neonates were studied with computed tomography (CT) of the brain in the neonatal period and again at 6 months of age. They were all followed clinically until at least 18 months of age. Eleven infants (8%) developed progressive hydrocephalus needing surgical intervention, and 67 (51%) had ventriculomegaly that was not diagnosed as progressive hydrocephalus during the 18-month-long follow-up period. All 11 neonates who developed progressive hydrocephalus had had hemorrhage, but ventriculomegaly without progressive hydrocephalus was very common and as common among those who had had hemorrhage as among those in whom no hemorrhage was found in the neonatal CT scan. We conclude from this study that, although posthemorrhagic hydrocephalus is a not infrequent complication of intracranial hemorrhage in neonates, the diagnosis should be made with caution, since ventriculomegaly of etiologies other than progressive hydrocephalus is common in this group of patients. The CT scan should be evaluated together with the clinical course of the patient. This combined approach will minimize the risks of a false positive diagnosis of progressive hydrocephalus and subsequent overtreatment as well as lack of treatment in cases in which it is necessary.