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Post-haemorrhagic hydrocephalus in the preterm infant
Australian Paediatric Journal
|August 1, 1985
Summary
Post-hemorrhagic hydrocephalus (PHH) affects 40% of infants surviving intraventricular hemorrhage (IVH). Serial cerebrospinal fluid (CSF) taps effectively manage PHH symptoms, potentially delaying the need for shunting.
Area of Science:
- Neonatal neurology
- Pediatric neurosurgery
- Clinical ultrasound
Background:
- Intraventricular hemorrhage (IVH) is a common complication in premature infants.
- Post-hemorrhagic hydrocephalus (PHH) is a significant sequela of IVH, requiring timely management.
- Understanding the incidence, risk factors, and outcomes of PHH is crucial for neonatal care.
Observation:
- Prospective study involving 220 low birth weight infants and 130 higher birth weight infants with IVH risk factors.
- Serial real-time ultrasound scans were used to monitor ventricular size and head circumference.
- PHH was defined using percentile charts for ventricular dilatation and head growth, alongside clinical signs of increased intracranial pressure (ICP).
Findings:
- The incidence of IVH was 22%, with 14 cases showing intracerebral extension.
- PHH developed in 40% of infants who survived the acute IVH phase.
- Severe birth asphyxia and intracerebral extension of IVH were identified as risk factors for PHH.
- Serial cerebrospinal fluid (CSF) taps effectively managed clinical symptoms of raised ICP and deferred the need for ventriculo-peritoneal (VP) shunting in 15 infants.
- High red blood cell count and protein concentration in CSF at PHH diagnosis predicted the need for VP shunting.
Implications:
- Serial CSF taps offer a minimally morbid, staged treatment approach for PHH, reducing the need for VP shunting.
- Early identification of risk factors and prompt management of PHH can improve short-term outcomes in neonates.
- Ultrasound monitoring and CSF analysis are valuable tools in diagnosing and managing PHH.