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Treatment of progressive posthemorrhagic hydrocephalus with temporary external ventricular drainage. Preliminary
Insights
Peri-intraventricular hemorrhage (PIVH) can lead to posthemorrhagic hydrocephalus (PHH) in preterm infants. Prompt external ventricular drainage is a safe initial treatment for PHH, controlling hydrocephalus and intracranial pressure.
Area of Science:
- Neonatal neurology
- Pediatric neurosurgery
Background:
- Peri-intraventricular hemorrhage (PIVH) affects over 40% of preterm infants (<1500g birth weight).
- Posthemorrhagic hydrocephalus (PHH) often follows severe PIVH, potentially due to posterior fossa arachnoiditis.
- Management of PHH in critically ill preterm infants presents significant challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of temporary external ventricular drainage (EVD) as an initial treatment for PHH in preterm neonates.
- To assess the impact of EVD on hydrocephalus and intracranial pressure in this vulnerable population.
Main Methods:
- Retrospective case series of three preterm infants with severe PIVH and developing PHH.
- Placement of temporary external ventricular drainage within two weeks of PIVH onset.
- Monitoring of ventricular dilatation and intracranial pressure via serial ultrasounds.
Main Results:
- All three patients demonstrated controlled hydrocephalus and reduced intracranial pressure within three weeks of EVD treatment.
- One infant expired due to complications unrelated to the hydrocephalus management.
- Early ultrasound detection of ventricular dilatation facilitated prompt EVD intervention.
Conclusions:
- Temporary external ventricular drainage is a safe and effective initial management strategy for posthemorrhagic hydrocephalus in preterm infants.
- Early diagnosis and intervention with EVD can successfully manage hydrocephalus and increased intracranial pressure following neonatal PIVH.
Abstract:
Peri-intraventricular hemorrhage (PIVH) is a major problem of preterm neonates: over 40% of infants with birth weight less than 1500 g have been found to experience this disorder. The posthemorrhagic hydrocephalus (PHH) is generally believed to occur secondary to obliterative posterior fossa arachnoiditis. Its management in critically ill premature infants with multiple medical problems has thus become quite significant. This paper reports the results of the placement of a temporary external ventricular drainage in three patients in whom progressive ventricular dilatation began within two weeks after severe neonatal PIVH. In all patients the hydrocephalus and increased intracranial pressure were controlled within three weeks of treatment. One infant died from other problems associated with his prematurity. Early demonstration of progressive ventricular dilatation by ultrasound and prompt external drainage has been found to be a safe initial method to treat PHH in preterm infants.