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Sudden infant apnea and insidious hydrocephalus
P Bromberger1, H E James, B Saunders
1Division of Neonatology, Kaiser Permanente Medical Center, San Diego, CA 92103.
Insights
Sudden cardiorespiratory arrest in preterm newborns can be caused by insidious hydrocephalus, a complication of intraventricular hemorrhage. Early recognition and treatment of ventricular enlargement are crucial for resolving these episodes.
Area of Science:
- Neonatology
- Pediatric Neurosurgery
- Neurocritical Care
Background:
- Intracranial-intraventricular hemorrhage is a frequent complication in high-risk preterm newborns.
- Hydrocephalus following hemorrhage can present insidiously without overt signs of intracranial hypertension.
- Apnea and respiratory arrest are significant concerns for preterm infants post-discharge.
Observation:
- A case is presented of a preterm infant experiencing severe cardiorespiratory arrest episodes.
- The episodes were linked to insidious, non-hypertensive hydrocephalus.
- Treatment of the hydrocephalus led to the resolution of cardiorespiratory events.
Findings:
- Insidious hydrocephalus, often undetected due to lack of hypertension, can manifest as serious cardiorespiratory events in preterm infants.
- Ventricular enlargement on neuro-imaging in asymptomatic preterm infants at discharge warrants attention.
- Neonatologists and pediatricians require increased awareness of this hydrocephalus syndrome.
Implications:
- Highlights a critical, under-recognized cause of cardiorespiratory events in high-risk preterm infants.
- Emphasizes the need for perinatal neurosurgical consultation and parental/pediatrician education regarding potential hydrocephalus.
- Suggests enhanced neuro-imaging surveillance and management protocols for preterm infants with a history of intraventricular hemorrhage.
Abstract:
Hydrocephalus secondary to intracranial-intraventricular hemorrhage is a common complication in the clinical course of the high-risk preterm newborn. Hydrocephalus in this population may be insidious without obvious intracranial hypertension. Apnea and respiratory arrest continue to cause concern following nursery discharge of the high-risk preterm newborn. We report a child who presented to the neonatology service with episodes compatible with serious sudden cardiorespiratory arrest. Insidious "non-hypertensive" hydrocephalus was documented as being responsible for these episodes, which resolved with treatment of the hydrocephalus. The perinatal neurosurgical consultant should be aware of this syndrome and instruct the parents and the pediatricians of these infants, who at the time of discharge are asymptomatic but have ventricular enlargement on neuro-imaging studies. The information presented here is of current importance, since most neonatologists are unaware of the syndrome of insidious hydrocephalus.