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Hydrocephalus secondary to intracranial hemorrhage in premature infants
Insights
Premature infants with low birth weight are prone to intracranial hemorrhage, which can lead to hydrocephalus. Surgical shunts are effective in managing this condition in survivors.
Area of Science:
- Neonatal neurology
- Pediatric neurosurgery
Background:
- Premature infants, particularly those with low birth weight, face a high risk of intracranial hemorrhage (ICH).
- Improvements in neonatal intensive care have increased survival rates for these infants, leading to a rise in cases of hydrocephalus secondary to ICH.
Observation:
- Seven cases of hydrocephalus following intracranial bleeding in premature infants are presented.
- Initial management attempts, including ventricular and lumbar punctures, were unsuccessful in controlling head growth.
- Temporary external ventriculostomy provided temporary but not permanent control of hydrocephalus.
Findings:
- Definitive treatment for hydrocephalus in these infants involved surgical shunting procedures.
- Ventriculoatrial shunts were used in two infants, while ventriculoperitoneal shunts were employed in five cases.
- Both shunt types were considered in the management of post-hemorrhagic hydrocephalus.
Implications:
- Early recognition and management of intracranial hemorrhage are crucial in premature infants.
- Surgical intervention, specifically shunting, is a viable and effective treatment for hydrocephalus in this vulnerable population.
- Further research into the pathogenesis and optimal management strategies for post-hemorrhagic hydrocephalus is warranted.
Abstract:
Premature (low birth weight) infants are particularly susceptible to intracranial hemorrhage. This frequently arises from the subependymal area and may dissect into the brain or into the ventricles. If the infant survives, hydrocephalus is a frequent sequela. Because of major improvements in the care of premature infants in recent years and the proliferation of intensive care nurseries, increasing numbers of low birth weight infants are surviving and developing hydrocephalus. Seven cases are described of infants who developed hydrocephalus following intracranial bleeding. Initially, ventricular and lumbar punctures were done to attempt to control head growth but this was unsuccessful. Two were treated with temporary external ventriculostomy which did not permanently control the hydrocephalus. Definitive treatment included ventriculo-atrial shunts using an expandable 'telescopic' cardiac catheter in two and ventriculoperitoneal shunts in five. The pathogenesis and management of the condition are discussed.