For very small babies with a buildup of fluid on the brain that requires a shunt to relieve cranial pressure, there's a very high risk of that'll have cognitive impairment and movement problems in early childhood, researchers report.
"Long-term follow-up is needed to determine whether adverse outcomes persist or improve over time," Dr. Ira Adams-Chapman of Emory University School of Medicine, Atlanta, and colleagues point out in the medical journal Pediatrics.
Extremely low birth weight infants with severe brain hemorrhage may develop hydrocephalus, or "water on the brain," which can lead to enlargement of the head and other problems. If it persists, a tube is inserted to drain the fluid from the brain into the abdominal cavity.
To see how such children fare, the investigators studied 6 161 infants born between weighing 401 to 1 000 grams who were followed-up at 18 to 22 months of age.
Thirteen percent of the group had hydrocephalus and three percent had a shunt inserted. The children needing a shunt, Adams-Chapman and colleagues report, had significantly lower scores on a standard infant development index than children with hydrocephalus of the same grade and no shunt.
Infants with shunts were also at increased risk for cerebral palsy at 18 months of age.
Overall, 86 percent of the children who had a shunt inserted for hydrocephalus exhibited impaired neurological development.
While a small subset (ie, 14 percent) of infants who required shunt insertion had no evidence of neurodevelopmental impairment at 18 to 22 months, "extended follow-up to school age is necessary before considering them unscathed," the researchers note.