Severe intracranial hemorrhage and hydrocephalus in low-birthweight infants treated with CSF shunts

Abstract

The high-risk low-birth-weight newborn not uncommonly develops intracranial hemorrhage and intraventricular hemorrhage (ICH/IVH) from the immature state of the germinal matrix. Posthemorrhagic hydrocephalus may develop. Infants with small hemorrhages (grades I, II of Papile), with or without hydrocephalus have been shown to develop normally in 80%-90% of cases. There is limited information in the literature about the management and outcome of infants with more severe hemorrhages (grades III, IV of Papile), due to the dismal outlook as to their outcome in most centers. The current status and concerns as to the management of these infants is reviewed, and the aspects of neurosurgical and neonatal follow-up and outcome are described. A significant number of these infants have severe handicaps, which are primarily motor. However, a group of infants is noted who have normal intellectual performance despite varying degrees of motor handicaps: 18% have normal intellectual and motor development. In the current series predictors of poorest outcome are the presence of grade IV hemorrhage and/or seizures. The vast majority of the grades III and IV hemorrhages develop hydrocephalus that is a complex management issue for the neurosurgeon.

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

“…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.…”