Rapidly Progressive Posthemorrhagic Hydrocephalus

External Ventricular Drainage for Initial Treatment of Neonatal Posthemorrhagic Hydrocephalus: Surgical and Neurodevelopmental Outcome

“…We discontinued use of Nafcillin prophylaxis when a study by Mayhall et al [38a] showed that Nafcillin did not influence the occur rence of infection in ventriculostomies. The rate of in fection in our patients is similar to a series published by Kreussner et al [31] who had 2 cases of ventriculitis in 19 patients or 38 drains, although duration of drainage was shorter in those cases than in ours. We feel the technique of tunnelling the catheter under the skin decreases the risk of infection [39,40].…”

“…Severe mental retardation occurred only in infants with severe spastic quadriplegia. This outcome is more encouraging than most other studies which have reported a high mortality rate as well as a high incidence of neurodevelopmental impairment, both cognitive and motor, in survivors of grade 4 hemorrhage [5,18,19,28,31,42,43]. Recent reports have raised the hypothesis that grade 4 hemor rhages may have a different pathogenesis than grade 2-3 IVH.…”

“…2). In two reported series using similar treatment methods, Kreussner et al [31] found that 85% of their group of 19 infants needed a perma nent shunt after external drainage, while Allen et al [10] reported the need for a shunt in only 30% of their group of 10. We started EVD earlier and left the external drains in longer than was reported in either of these series.…”

“…Medical treatment has included head wrap ping, diuretics and intermittent CSF drainage by lumbar or ventricular taps [9,11,[24][25][26][27][28]. Surgical methods have included decompression of the ventricles by the direct placement of a VP or ventriculoatrial shunt [29,30], by continuous EVD using various techniques [10,22,31] or by placing a subcutaneous ventricular catheter reservoir for intermittent taps [32, 32a, 33], McComb et al [32] used subcutaneous ventricular reservoirs in 20 patients, all with grade 3 or 4 hemorrhage. There was 65% mor tality, and of the survivors 43% did not require a VP shunt.…”

Epidemiology of Infantile Hydrocephalus in Sweden

“…Our findings agree well with data from recent series of very preterm infants consecutively examined with ultrasound in the neonatal period. Kreusser et al (6) stated that posthaemorrhagic IH remains a major complication of IVH in low-birth-weight infants, appearing in up to 80% of survivors of large IVH. There are also clear indications that the risk of major IVH (grade 111-IV haemorrhage) increases with decreasing GA (1, 3, 6).…”