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 +/- 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 +/- 2.2 vs 5.9 +/- 1.4), family-personal (26.6 +/- 5.2 vs 20.2 +/- 2.8), and disruptive social (21.4 +/- 4.9 vs 16.7 +/- 3.1) domains (P < 0.001). Multivariate regression incorporating neonatal risk factors revealed an independent effect of parenchymal brain involvement (beta:0.4, P:0.002) and neonatal seizures (beta: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 (beta:0.5, p:0.002) and socioeconomic status (beta:-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.