Impact of posthemorrhagic ventricular dilatation on cerebral oxygenation in preterm infants with intraventricular hemorrhage

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Abstract
Background: To assess the longitudinal effects of intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilatation (PHVD) on cerebral oxygenation using near-infrared spectroscopy (NIRS). Methods: This prospective cohort study included preterm neonates born 2 ) was measured from IVH diagnosis until term-equivalent age. Duration of abnormal rScO 2 values (85%) and cerebral fractional tissue oxygen extraction (cFTOE) were analyzed. Results: A total of 154 preterm infants with IVH (median gestational age: 25 +4 weeks) were included, of whom 65 (42.2%) developed PHVD, with 56 (86.2%) requiring temporizing neurosurgical intervention. Analysis of over 30,000 hours of NIRS data revealed a significant decline in cerebral oxygenation with increasing IVH severity ( p = 0.023). Infants with PHVD had lower rScO₂ ( p < 0.001), spent more time with rScO 2 < 55% ( p < 0.001), and exhibited higher cFTOE ( p < 0.001) than those without PHVD. Within the PHVD group, more interventions were associated with lower rScO 2 levels ( p = 0.010) and higher cFTOE values ( p = 0.005). Conclusion: IVH and PHVD profoundly impair cerebral oxygenation. High-grade IVH leads to rScO 2 deterioration, further exacerbated in infants with greater PHVD burden. These findings highlight the need for targeted strategies to stabilize cerebral oxygenation in this vulnerable population. Impact: Cerebral oxygenation declines with increasing intraventricular hemorrhage (IVH) severity in preterm infants. Posthemorrhagic ventricular dilatation (PHVD) severity, reflected by the number of neurosurgical interventions, is linked to worsening cerebral oxygenation and increased oxygen extraction. This prospective cohort study provides a comprehensive longitudinal dataset using near-infrared spectroscopy (NIRS) to link IVH severity and PHVD to cerebral oxygenation dynamics. Findings underscore the urgent need for targeted neuroprotective interventions to stabilize brain oxygenation in preterm infants with severe IVH and PHVD.

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