Post-hemorrhagic ventricular dilatation and hydrocephalus in preterm infants: a five-year retrospective cohort study from a tertiary referral center

Post-hemorrhagic hydrocephalus (PHH) is a serious complication of intraventricular hemorrhage (IVH) in preterm infants and is associated with increased morbidity and mortality. Although neonatal risk factors are well described, the contribution of maternal and perinatal factors remains inconsistent across studies. To determine the incidence, clinical characteristics, and independent predictors of PHH among preterm neonates with IVH, and to evaluate early outcomes in a tertiary referral center. This retrospective cohort study included preterm neonates (< 34 weeks’ gestation or birth weight ≤ 1500 g) with ultrasound-confirmed IVH admitted to Namazi Hospital, Shiraz, Iran, between March 2019 and March 2024. Demographic, maternal, perinatal, and neonatal variables were extracted from medical records. PHH was defined as progressive ventricular dilatation following IVH. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of PHH. Among 507 neonates with IVH, 154 (30.4%) developed PHH. Infants with PHH had significantly lower birth weight and gestational age and higher rates of maternal diabetes and neonatal meningitis.Each 100-g increase in birth weight was associated with a 24% reduction in the odds of developing post-hemorrhagic hydrocephalus (OR 0.76; 95% CI 0.7–0.83; p < 0.001).Maternal gestational diabetes mellitus/diabetes was a significant risk factor (OR 2.14; 95% CI 1.39–3.29; p = 0.001) Antenatal steroid exposure was associated with lower odds of PHH, possibly reflecting reduced hemorrhage severity(OR 0.53; 95% CI 0.35–0.80; p = 0.003).Mortality was borderline higher among infants with PHH ( p = 0.05), while the need for surgical intervention was significantly higher in this group ( p < 0.001).The primary clinical model demonstrated good calibration (Hosmer–Lemeshow p = 0.19) and acceptable discrimination (AUC = 0.75). PHH remains a frequent and severe complication of IVH in preterm neonates. Both neonatal and selected maternal factors contribute to PHH risk, underscoring the importance of comprehensive perinatal assessment and early identification of high-risk infants.