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Positional moulding in premature hydrocephalics
1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India. rajkumar@sgpgi.ac.in
Insights
Lambdoid positional molding (LPM) in premature infants with hydrocephalus did not impact outcomes. Associated intracranial anomalies, not LPM, were linked to poor neurodevelopmental function in these children.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Hydrocephalus in premature infants presents significant neurodevelopmental challenges.
- Lambdoid positional molding (LPM) is a common cranial deformity in infants.
- The impact of LPM on neurodevelopmental outcomes in hydrocephalic infants requires clarification.
Observation:
- Seven premature infants with hydrocephalus and LPM were analyzed.
- Common hydrocephalus etiologies included aqueductal stenosis, Dandy Walker Syndrome, and infection.
- Associated intracranial anomalies such as hemorrhage, atrophy, and malformations were frequently observed.
Findings:
- Infants with hydrocephalus and LPM showed suboptimal higher mental function development post-treatment.
- The poor neurodevelopmental outcomes were primarily attributed to associated intracranial anomalies, not LPM itself.
- Differentiation between LPM and posterior plagiocephaly is crucial for accurate diagnosis.
Implications:
- Intracranial anomalies are key determinants of neurodevelopmental prognosis in hydrocephalic infants with LPM.
- Clinical management should focus on addressing underlying brain abnormalities rather than solely on cranial molding.
- Further research is needed to elucidate the complex interplay between hydrocephalus, intracranial anomalies, and neurodevelopmental trajectories.
Abstract:
Seven premature hydrocephalics presenting with lambdoid positional moulding (LPM) were reviewed. All were treated for hydrocephalus secondary to aqueductal stenosis, Dandy Walker Syndrome and infection. Parenchymal hemorrhage, intraventricular bleed, cortical atrophy, septal agenesis, cortical anomalies and subdural hygroma were the other common associations. These children did not show expected improvement in their higher mental functions at 6 months to 5.4 years of follow-up, following the management of hydrocephalus. It was not the LPM but associated intracranial anomalies, which were most probably responsible for their poor outcome. The differentiation from posterior plagiocephaly is also highlighted.