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Epidemiology of post-hemorrhagic ventricular dilatation in very preterm infants



To describe the incidence, trends, management’s variability and short-term outcomes of preterm infants with severe post-hemorrhagic ventricular dilatation (sPHVD).


We reviewed infants <33 weeks’ gestation who had PHVD and were admitted to the Canadian Neonatal Network between 2010 and 2018. We compared perinatal characteristics and short-term outcomes between those with sPHVD and those with mild/moderate PHVD and those with and without ventriculo-peritoneal (VP) shunt.


Of 29,417 infants, 2439 (8%) had PHVD; rate increased from 7.3% in 2010 to 9.6% in 2018 (P = 0.005). Among infants with PHVD, sPHVD (19%) and VP shunt (29%) rates varied significantly across Canadian centers and between geographic regions (P < 0.01 and P = 0.0002). On multivariable analysis, sPHVD was associated with greater mortality, seizures and meningitis compared to mild/moderate PHVD.


Significant variability in sPHVD and VP shunt rates exists between centers and regions in Canada. sPHVD was associated with increased mortality and morbidities.

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Fig. 1: Study population flow chart.
Fig. 2: Adjusted Standardized Ratios of Severe PHVD Between Canadian Tertiary Neonatal Units Abbreviation: sPHVD, severe post-hemorrhagic ventricular dilatation.


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The authors gratefully acknowledge all site investigators and abstractors of the Canadian Neonatal Network (CNN). We thank the staff at the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada for organizational support. We also thank Heather McDonald Kinkaid, PhD, a scientific writer at MiCare, for editorial support in preparing this manuscript.


The project described in this manuscript was conducted with no specific financial support. No honorarium, grant, or other form of payment was given to anyone to produce this manuscript. Organizational support for the Canadian Neonatal Network™ was provided by the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by the Canadian Institutes of Health Research (CIHR) (CTP 87518) and Mount Sinai Hospital. PS holds a CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340).

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JA conceptualized and designed the study, drafted the manuscript, and adjusted the manuscript according to the comments of co-authors. WE and PS overviewed the study design and interpretation of data and provided critical revision of the manuscript for important intellectual content. PS and XY had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis. All authors provided review and critical appraisal of the manuscript and approved the final version to be published.

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Correspondence to Jehier Afifi.

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Afifi, J., Shah, P.S., Ye, X.Y. et al. Epidemiology of post-hemorrhagic ventricular dilatation in very preterm infants. J Perinatol 42, 1392–1399 (2022).

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