Related Experiment Videos
[Results of early external ventricular diversion in posthemorrhagic ventricular dilatation in the newborn]
1Servizio di Anestesia e Rianimazione, Istituto G. Gaslini, Genova.
Insights
Early long-term external ventricular drainage (EVD) effectively manages progressive post-hemorrhagic ventricular dilatation (PPHVD) in preterm newborns. This approach shows a low complication rate and reduces the need for permanent shunts.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Critical Care Medicine
Background:
- Progressive post-hemorrhagic ventricular dilatation (PPHVD) is a serious complication in preterm infants following peri-intraventricular hemorrhage (PIVH).
- Effective management is crucial to prevent neurological damage and long-term disability.
Purpose of the Study:
- To evaluate the outcomes of early, long-term external ventricular drainage (EVD) for PPHVD in preterm neonates.
- To assess the safety, efficacy, and complication rates associated with prolonged EVD.
Main Methods:
- A cohort of 21 preterm infants (29.6 ± 2.4 weeks gestational age) with grade III and IV PIVH-induced PPHVD were treated with early EVD.
- EVD was maintained for an average of 40 ± 16 days, utilizing specialized equipment and anesthetic protocols.
- Diagnosis of PPHVD was confirmed via ultrasound and CT scans.
Main Results:
- All patients demonstrated a reduction in ventricular size following EVD.
- A low complication rate was observed: 5% with cerebrospinal fluid (CSF) infection, and no catheter obstructions or dislocations.
- Mortality was 14% due to respiratory complications; 33.5% required ventriculo-peritoneal shunts, while 52.5% became shunt-free.
Conclusions:
- Long-term EVD is a safe and effective treatment for PPHVD in preterm infants, with a low risk of complications.
- EVD helps manage intracranial pressure, allows CSF monitoring, and decreases the need for permanent shunts.
- This approach provides a bridge to potential natural CSF circulation recovery.
Objective And Design:
The authors report the outcome of early treatment with long-term external ventricular drainage (EVD) of progressive post-hemorrhagic ventricular dilatation (PPHVD), following peri-intraventricular hemorrhage (PIVH) in a population of preterm newborns.
Setting:
Neonatal Intensive Care Unit (NICU) of a Children's Hospital.
Patients:
Twenty-one preterms of 29.6 +/- 2.4 weeks of gestational age, weighing at birth 1443 +/- 445 g, mechanically ventilated, submitted to early EVD because of PPHVD following PIVH of III (n 11) e IV (n 10) grade.
Methods:
PPHVD was diagnosed on the basis of US and TC findings. An external liquoral drainage suitable, for its technical characteristics, to be maintained for a long period of time and peculiar anesthesiologic, intra and postoperative treatments were utilized.
Results:
EVD was placed at 21 +/- 5.8 days of life and maintained for 40 +/- 16 days. In all cases reduction of ventricular size was observed. One case (5%) developed liquoral infection and recovered with antibiotic therapy. No obstruction or dislocation of the ventricular catheter occurred. During EVD 3 patients (14%) died because of respiratory complications. After the normalization of cerebrospinal fluid (CSF), a "permeability test" was performed to assess the canalization of the liquoral system. Seven patients (33.5%) underwent ventriculo-peritoneal shunt (VPS) and 11 (52.5%) became shunt-free.
Conclusions:
Our results indicate that long-term use of EVD has a low risk of complications, avoids the need for transcutaneous tips and allows monitoring of CSF characteristics. Furthermore EVD protects the brain from liquoral hypertension, while waiting for a possible recurrence of natural CSF circulation, and is associated with a low number of definitive VPS.