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[Germinal matrix hemorrhage and hydrocephalus in premature infants]
M Dehara1, K Morimoto, O Takemoto
1Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
Insights
This study shows that a miniature Ommaya
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
Context:
- Intraventricular hemorrhage (IVH) is a significant concern in premature infants.
- Progressive hydrocephalus often complicates severe IVH (grade 3-4).
- Surgical intervention is considered for refractory cases.
Purpose:
- To evaluate the efficacy of a two-stage surgical approach for post-hemorrhagic hydrocephalus in preterm infants.
- To assess mortality, cognitive, and motor outcomes in this cohort.
- To determine the utility of a miniature Ommaya's reservoir in managing this condition.
Summary:
- A cohort of 25 preterm infants with grade 3-4 IVH and progressive hydrocephalus underwent surgical treatment.
- The procedure involved initial placement of a miniature Ommaya's reservoir followed by ventriculoperitoneal shunt diversion.
- Successful outcomes, including ambulatory status and improved cerebroventricular index, were observed in 64.7% of patients.
Impact:
- The miniature Ommaya's reservoir demonstrates effectiveness in treating post-hemorrhagic hydrocephalus refractory to conservative measures.
- This approach offers a viable option for improving outcomes in high-risk premature infants with severe IVH.
- Advances in perinatal medicine contribute to increasing survival rates for low birth weight infants.
Abstract:
An analysis of 25 preterm infants with grade 3 or 4 intraventricular hemorrhage and surgically treated progressive hydrocephalus was undertaken to assess mortality, cognitive outcome and motor deficit. All patients underwent surgery at the author's institute since 1981 and represented 4.7% of all intraventricular hemorrhage in premature infants. Surgical procedure was initial placement of a miniature Ommaya's reservoir and conversion to a ventriculoperitoneal shunt diversion. Overall, outcomes were achieved in 64.7% of ambulatory and improvement of cerebroventricular index on follow-up CT image from 0.68 +/- 0.36% to 0.36 +/- 0.31%. The presence of intraventricular hemorrhage continues to be a major problem in low birth weight infants whose rate survival continues to increase as the major improvements in perinatal medicine. We feel that miniature Ommaya's reservoir is quite helpful in the treatment of posthemorrhagic hydrocephalus in the preterm infant who prove refractory to aggressive conservative therapy.