What is the ideal initial valve pressure setting in neonates with ventriculoperitoneal shunts?

In order to determine the optimal valve pressure setting during the first weeks in neonates after implantation of programmable Hakim valves and to analyze the benefits and possible side effects of a new treatment protocol in this age group, we performed this prospective study. In 20 consecutive newborns less than 5 weeks of age with hydrocephalus due to various etiologies, a ventriculoperitoneal shunt with a programmable Hakim valve at an extremely low initial valve pressure setting of 30-40 mm H(2)O was implanted. This "overdrainage" was maintained, monitored by regular clinical examination and transcranial ultrasonographic imaging, until the wound healing was uneventfully completed and the permanent valve pressure setting of 100-120 mm H(2)O was chosen. In this age group, which is prone to specific noninfectious shunt complications like wound breakdown, cerebrospinal fluid (CSF) fistula and subcutaneous CSF collections, none of these complications were seen, nor were there any persisting overdrainage phenomena on transcranial ultrasonography. Initial, temporary "overdrainage" represents a simple, useful and risk-free therapy in neonates with programmable shunts which might lower the incidence of typical noninfectious complications in this age group.