Posthemorrhagic hydrocephalus in low-birth-weight infants: Treatment by serial lumbar punctures

Papile, Lu-Ann; Burstein, Jerome; Burstein, Rochelle; Koffler, Herbert; Koops, Beverly L.; Johnson, John D.

doi:10.1016/s0022-3476(80)80494-x

Cited by 110 publications

(17 citation statements)

References 15 publications

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“…Because of these many difficulties, numerous means for controlling hydrocephalus in preterm infants have been used, including medical management (acetazolamide, furosemide) [1], serial lumbar punctures [2][3][4], serial ventricular punctures [5], external ventricular drainage (EVD) [6,7], ventriculoperitoneal shunt [8], ventriculosubgaleal shunt [9,10] and the subcutaneous ventricular reservoir or ventricular access device (VAD) [11,12]. As is usually the situation when there are many different methods of treatment, no single intervention is clearly the best.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Posthemorrhagic Hydrocephalus in the Preterm Infant with a Ventricular Access Device

Hudgins

Boydston²,

Gilreath³

1998

Pediatr Neurosurg

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Intraventricular hemorrhage (IVH) and subsequent posthemorrhagic hydrocephalus (PHH) commonly complicate the course of extremely preterm infants. Many methods for treating the hydrocephalus have been used, none of which are ideal. We present the largest series of infants with PHH treated with one modality, the ventricular access device (VAD). One hundred and forty-nine preterm infants with PHH were treated by placement of a VAD and serial taps to control intracranial pressure and ventricular size. Variables recorded include gender, race, gestational age, weight at birth, IVH grade, incidence of VAD infection, malfunction or local wound problems and indwelling time to either shunt placement or VAD removal. Of the 149 preterm infants, 91 were males and 58 females. The average birth weight was 994 g and the average gestational age at birth was 26.3 weeks. Three infants were IVH grade 1, 8 were grade 2, 62 were grade 3 and 76 were grade 4. VAD occlusion occurred in 15 infants (10%). Nine infants required contralateral VAD placement for a trapped ventricle. VAD infection occurred in 12 infants (8%), 5 of whom were treated successfully with a combination of systemic and intra-VAD antibiotics without removal of the VAD. The total rate of revision was thus 20% (15 for occlusion, 9 for trapped ventricle, 7 for infection). Wound problems were minimal and consisted of 4 cerebrospinal fluid leaks and 14 subgaleal fluid collections. For the 133 survivors, the rate of shunt placement was 88%. The VAD, while not ideal, is an excellent treatment at this time for PHH. It can be utilized for several months with acceptable rates of infection, blockage and wound complications. The VAD tap is simple to perform, not disruptive to minimal stimulation protocols, and can be done by physician extenders. In addition, medications can be administered via the access device, thus allowing treatment of some infections without VAD removal as well as instillation of thrombolytic agents such as urokinase.

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Section: Introductionmentioning

confidence: 99%

Treatment of Posthemorrhagic Hydrocephalus in the Preterm Infant with a Ventricular Access Device

Hudgins

Boydston²,

Gilreath³

1998

Pediatr Neurosurg

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“…The purpose of our report was to draw attention to the occurrence of electrolyte disturbances during repeated CSF drainage. Previous reports have specifically stated that this was not a problem.4 5 …”

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confidence: 45%

Hyponatraemia and CSF drainage in posthaemorrhagic hydrocephalus

Singh¹

1983

Archives of Disease in Childhood

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“…The birthweight of the 50 infants was mean (SD), 888 (204) g, (range 430-1250 g) and their gestational age was mean (SD), 27 (4) weeks, (range 24-32 weeks). Table 1 shows selected perinatal data.…”

Section: Resultsmentioning

confidence: 99%

Timing and evolution of periventricular haemorrhage in infants weighing 1250 g or less at birth.

Szymonowicz¹,

Yu²

1984

Archives of Disease in Childhood

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SUMMARY The brains of 50 consecutively admitted infants who weighed 1250 g or less at birth were examined with real time ultrasound. Of 30 (60%) who had periventricular haemorrhage (PVH), 19 (63%) bled on the first day and 17 (57%) showed extension of the initial haemorrhage on serial scans. The median age was 16 hours when PVH was first detected and 48 hours when PVH reached its maximum extent. Ventricular size at birth correlated with gestation. Progressive ventricular growth was seen after birth in infants both with and without PVH. Charts of normal ranges of ventricular size and head circumference were drawn up from birth to 10 weeks of age. All infants with PVH showed a transient increase in ventricular size at 2 weeks of age but most returned to normal by 6 weeks of age. Ventricular dilatation after PVH that was greater than the 95th centile for this population developed in 5 (31%) of 16 survivors, four of whom subsequently developed hydrocephalus, although none required ventriculo peritoneal shunting. The optimal timing for diagnosis with ultrasound is at the end of the first week for PVH and the second to third week for ventricular dilatation.

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Posthemorrhagic hydrocephalus in low-birth-weight infants: Treatment by serial lumbar punctures

Cited by 110 publications

References 15 publications

Treatment of Posthemorrhagic Hydrocephalus in the Preterm Infant with a Ventricular Access Device

Treatment of Posthemorrhagic Hydrocephalus in the Preterm Infant with a Ventricular Access Device

Hyponatraemia and CSF drainage in posthaemorrhagic hydrocephalus

Timing and evolution of periventricular haemorrhage in infants weighing 1250 g or less at birth.

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