The impact of neonatal posthemorrhagic hydrocephalus of prematurity on family function at preschool age.

AIMS: To determine the impact on families (IOF) of former preterm infants (gestational age < 32 weeks) after posthemorrhagic hydrocephalus requiring shunt (PHH-S), and to identify risk factors of family dysfunction. STUDY DESIGN: 38 preterm infants with PHH-S were matched for gestational age, birthweight, and gender with preterm infants with normal cranial ultrasonography. IOF questionnaire was administered at 5.7 ±â€¯2 years (higher IOF score indicates worse impact). RESULTS: Families of PHH-S children exhibited significantly worse IOF compared to controls in financial (9.2 ±â€¯2.2 vs 5.9 ±â€¯1.4), family-personal (26.6 ±â€¯5.2 vs 20.2 ±â€¯2.8), and disruptive social (21.4 ±â€¯4.9 vs 16.7 ±â€¯3.1) domains (P < 0.001). Multivariate regression incorporating neonatal risk factors revealed an independent effect of parenchymal brain involvement (ß:0.4, P:0.002) and neonatal seizures (ß:0.3, p:0.007) on total IOF. Neurosensory morbidity was significantly higher in the PHH-S group, including cerebral palsy (81.6%), epilepsy (47.4%), problems with vision (63.2%), feeding (39.5%) and hearing (18.4%), chronic health problems (44.7%) and hospital admissions in the last 6 months (44.7%). Worse IOF scores of PHH-S families were associated with socioeconomic status and neurodevelopmental morbidities: cerebral palsy severity, feeding problems, number of neurosurgeries, low cognitive, personal-social, and adaptive scores (P < 0.05). Multivariate analysis indicated an independent contribution from cerebral palsy severity (ß:0.5, p:0.002) and socioeconomic status (ß:-0.4, P: 0.01). CONCLUSIONS: Families of preterm children after PHH-S exhibit significantly worse IOF scores compared to families of preterm peers. Worse IOF is associated with severe hemorrhage, neurodevelopmental morbidities and socioeconomic status. A family centered intervention is warranted after PHH-S.

Health-related quality of life after post-haemorrhagic hydrocephalus in children born preterm.

AIM: To determine the health-related quality of life (HRQoL) of children born preterm (gestational age <32wks) after post-haemorrhagic hydrocephalus requiring shunt (PHH-S), and to examine the impact of perinatal and neurological morbidity on their QoL. METHOD: Forty infants (18 females, 22 males; aged 2y 2mo-8y 4.5mo) born preterm with PHH-S were matched for gestational age, birthweight, and sex with infants born preterm with normal cranial ultrasonography. Pediatric QoL Inventory parent-proxy report was administered at a mean age of 5 years 8 months. RESULTS: Children with PHH-S exhibited significantly lower mean HRQoL compared with controls in motor (36 [SD 34.9] vs 96.2 [SD 6.6]), emotional (59.8 [SD 26.7] vs 80.6 [SD 18.8]), social (55.6 [SD 29.7] vs 89.6 [SD 16.6]), and school (40.5 [SD 22.9] vs 89.7 [SD 15.2]) domains (p<0.001). Multivariate regression incorporating neonatal risk factors revealed an independent effect of parenchymal brain involvement (ß=-0.6, p<0.01) and neonatal seizures (ß=-0.2, p<0.02) on total HRQoL. Low HRQoL of children with PHH-S was associated with neurodevelopmental morbidities: cerebral palsy (CP), epilepsy, vision and feeding problems, low cognitive, personal-social, and adaptive scores (p<0.05). Multivariate analysis indicated an independent contribution from severe CP (ß=-0.4, p<0.001) and low personal-social score (ß=0.5, p<0.001). INTERPRETATION: Children born preterm after PHH-S exhibit significantly lower HRQoL scores compared with preterm born peers. HRQoL is associated with neonatal cerebral complications and neurodevelopmental morbidities. WHAT THIS PAPER ADDS: Children born preterm, after post-haemorrhagic hydrocephalus requiring shunt, have low health-related quality of life (HRQoL). A low HRQoL is associated with parenchymal brain involvement and with neurological morbidity. Severe cerebral palsy and low personal-social developmental scores have independent contributions to HRQoL.