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

Abstract

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 (β=−0.6, p<0.01) and neonatal seizures (β=−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 (β=−0.4, p<0.001) and low personal–social score (β=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.