Management of Hydrocephalus Secondary to Intracranial Hemorrhage in the High Risk Newborn

James, Hector E.; Bejar, Raul; Merritt, Allen; Gluck, Louis; Coen, Ronald W.; Mannino, Frank L.

doi:10.1227/00006123-198405000-00020

Cited by 20 publications

(9 citation statements)

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“…Dykes et al [4], citing a 46% overall shunt avoidance rate in infants with symptomatic and asymptomatic PHH, advocate either close observation or serial lumbar punctures as initial management. On the other hand, some groups [15][16][17] advocate early shunting of these infants. In the middle are those who initially use a combined medical and surgical approach to PHH aimed at serial reduc tion of CSF volume by LPs and/or VCR placement [22][23][24][25] followed by a shunting procedure if required.…”

Section: Discussionmentioning

confidence: 99%

“…Inter mittent reduction of cerebrospinal fluid (CSF) volume by lumbar puncture (LP) [3,4,7], direct ventricular tap, pharmacologic reduction of CSF production by furosemide or acctazolamide [10,11], head wrapping [12], external ventricular drainage [13,14] and ventriculoperitoneal/ventriculoatrial [15][16][17][18] or ventriculosubcutaneous [19] shunting procedures have all been used to manage PHH with varying degrees of success. Recently, intermittent reduction of CSF volume via a ventricular catheter reservoir (VCR) has become an accepted alter native or adjunct to the above therapies.…”

Section: Introductionmentioning

confidence: 99%

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Management of Posthemorrhagic Hydrocephalus in the Low-Birth-Weight Preterm Neonate

Brockmeyer¹,

Wright²,

Walker³

et al. 1989

Pediatr Neurosurg

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Over a period of 34 months from 1987 to 1990 we inserted ventricular catheter reservoirs (VCR) into 20 premature low-birth-weight infants who had developed progressive, symptomatic posthemorrhagic hydrocephalus following grade III or IV intraventricular hemorrhages. The mean estimated gestational age was 27.7 ±5.3 weeks and mean birth weight was 1,041 ±699 g. The ventricular catheter reservoirs were placed on day of life 30.7 ± 29.7 and tapped for a total of 3–34 days at varying frequencies and for varying volumes. Of the 20 patients, 4 died on days of life 25, 76, 88, and 187. There were two reservoir infections, both occurring in infants who eventually died. The 16 survivors have been followed from 2 to 24 months (adjusted age). Four (25%) remain shunt-free and 3 have undergone VCR removal. There have been two shunt infections in the 12 shunted patients; ten shunt revisions have been performed overall. At the time of last follow-up, 14 patients were old enough to undergo neurodevelopmental evaluation. Five patients (36%) were ‘normal’ on gross neurological screening examination, 5 (36%) had ‘mild developmental delay’ and 4 (28%) had ‘significant developmental delay’. We feel these data support the continued use of ventricular catheter reservoirs in the management of posthemorrhagic hydrocephalus and offer hope that some of these patients might remain shunt-free and most will have a normal or mildly delayed neurodevelopmental outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of Posthemorrhagic Hydrocephalus in the Low-Birth-Weight Preterm Neonate

Brockmeyer¹,

Wright²,

Walker³

et al. 1989

Pediatr Neurosurg

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“…The patients are followed by serial physical examinations and cribside ultrasonography [4,6,8], The frequency of cranial ultrasonogra phy is determined by the patients underlying pathology and/or changes in the clinical course and when ventriculomegaly is identi fied. When ventriculomegaly is nonprogressive, no therapy is in stituted [10,12,13]. In progressive ventriculomegaly intermittent lumbar punctures are performed until there is stabilization of the en larging ventricles or the need for a ventriculoperitoneal shunt (VPS), because of progressive hydrocephalus [1,12,13].…”

Section: Methodsmentioning

confidence: 99%

“…When clots from the intraventricular hemorrhage and the high protein content of the CSF interfere with the normal circulation and reabsorption of CSF, hydrocephalus results [4,10,12,17]. Impairment of CSF flow may be present for hours, days, weeks or become permanent [4,5,10,13].…”

Section: Introductionmentioning

confidence: 99%

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Insidious Hydrocephalus in the Preterm Newborn following Discharge from the Nursery

James¹,

Bejar

Merritt

et al. 1987

Pediatr Neurosurg

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Posthemorrhagic ventriculomegaly may be due to perinatal brain damage and consequent cerebral atrophy, or represent progressive hydrocephalus due to impairment of CSF flow and reabsorption. ‘Arrested’ hydrocephalus occurs when the CSF pathways are adequate and, hence, intracranial hypertension no longer exists. The differential diagnosis is often difficult and insidious progressive hydrocephalus should always be a concern in the high-risk preterm newborn. We report 10 preterm infants who were discharged with the diagnosis of arrested hydrocephalus (7) or cerebral atrophy (3), and who later developed progressive severe hydrocephalus 1.5–15 months after the discharge. Five had been treated with intermittent lumbar punctures, while 4 had not received any treatment prior to nursery discharge. One infant died prior to the shunt procedure. Progressive insidious hydrocephalus should be suspected in preterm infants with intracranial hemorrhage following discharge from the nursery.

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Germinal Matrix Hemorrhage (GMH) Syndrome and Intraventricular Hemorrhage (IVH) Syndrome in the Newborn

Haase¹

1986

Principles of Pediatric Neurosurgery

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Management of Hydrocephalus Secondary to Intracranial Hemorrhage in the High Risk Newborn

Abstract: The experience of the Special Care Nursery of the University of California Medical Center, San Diego, in the management of the high risk newborn with progressive ventricular enlargement is reviewed, and the physiopathological basis of progressive ventricular enlargement is analyzed.

Cited by 20 publications

References 0 publications

Management of Posthemorrhagic Hydrocephalus in the Low-Birth-Weight Preterm Neonate

Management of Posthemorrhagic Hydrocephalus in the Low-Birth-Weight Preterm Neonate

Insidious Hydrocephalus in the Preterm Newborn following Discharge from the Nursery

Germinal Matrix Hemorrhage (GMH) Syndrome and Intraventricular Hemorrhage (IVH) Syndrome in the Newborn

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