Medical management of neonatal posthemorrhagic hydrocephalus

Posthemorrhagic hydrocephalus is a relatively common complication of premature birth. One third of patients who do not undergo spontaneous resolution require medical management aimed at normalizing intracranial pressure by correcting the imbalance between cerebrospinal fluid (CSF) production and drainage. Serial lumbar punctures intermittently remove CSF in bulk. Pharmacologic therapy decreases CSF production. Each of these therapies have attendant benefits and risks. For patients whose CSF absorption does not improve with growth and recovery, placement of an indwelling ventricular drain is ultimately required.