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[External ventricle drainage in newborn infants with rapidly growing posthemorrhagic hydrocephalus]
M Weninger1, G Simbruner, H R Salzer
1Abteilung für Neonatologie, Universitäts-Kinderklinik, Wien.
Insights
External ventricular drainage effectively treats hydrocephalus in newborns by reducing intracranial pressure. While some infants require shunts later, this method offers a crucial initial therapy for progressive ventricular dilatation.
Area of Science:
- Neonatal Medicine
- Pediatric Neurosurgery
- Critical Care
Context:
- Post-hemorrhagic hydrocephalus is a serious condition in newborns.
- Increased intracranial pressure poses significant risks to infants.
- Rapidly progressive hydrocephalus requires prompt intervention.
Purpose:
- To evaluate the efficacy of external ventricular drainage (EVD) in managing neonatal hydrocephalus.
- To assess the short-term and long-term outcomes of EVD in this population.
- To determine the safety and complications associated with EVD in newborns.
Summary:
- 14 newborns with progressive hydrocephalus and increased intracranial pressure underwent external ventricular drainage.
- EVD successfully arrested hydrocephalus progression during treatment, with drainage lasting an average of 20 days.
- While 80% of survivors eventually needed shunts, EVD provided effective initial pressure management without complications like ventriculitis.
Impact:
- External ventricular drainage is a safe and effective initial treatment for neonatal post-hemorrhagic hydrocephalus.
- This intervention can stabilize infants, allowing for better management of intracranial pressure.
- Early EVD may improve neurological outcomes by preventing severe brain damage from elevated pressures.
Abstract:
14 newborn infants (birth weight: 1830 +/- 930 gms, gestational age 33 +/- 4 wks) (mean +/- SD) with rapidly progressive posthaemorrhagic hydrocephalus and increased intracranial pressure were treated by means of external ventricular drainage. Progression of hydrocephalus was arrested during the drainage period in each patient. The drainage was kept in place for 20 +/- 12 days, the longest drainage period being 48 days. 8 of 10 surviving patients showed recurrence of progressive ventricular dilatation, 5 required a ventriculoatrial and 3 a ventriculoperitoneal shunt. The other 2 infants required no further therapy. Implantation of a permanent shunt was performed at day 28 to 88 after delivery, at the time of implantation the weight of the infants was 2400 +/- 950 gms (lowest weight 1650 gms). Bacterial cultures of ventricular liquor were negative in 66 and positive in 7 instances. Clinical and biochemical evidence of ventriculitis was absent in all patients. 4 of the 14 patients died of causes unrelated to external ventricular drainage. 10 infants survived. 7 out of 10 survivors suffered from IVH 3; 6 subsequently showed normal neurological development and one was retarded. 3 patients with parenchymal lesions (2 patients: IVH 4, 1 patient: primarily intraparenchymal haemorrhage) had neurological handicaps. We consider external ventricular drainage to be an effective form of therapy in newborn infants with rapidly progressive posthaemorrhagic hydrocephalus and increased intracranial pressure because this treatment achieves prompt and sustained decrease in intraventricular pressure without complications.