To control hydrocephalus resulting from massive intraventricular hemorrhage in premature neonates with respiratory distress syndrome, we inserted a specially designed low profile subcutaneous ventricular catheter reservoir (reservoir) by the 12th day of life (average; range, 3 to 30 days) in 20 neonates whose mean birth weight was 1110 +/- 270 g (28.7 +/- 1.6 weeks of gestation). The reservoir was repeatedly aspirated over 10 to 48 days. No cerebrospinal fluid infection, reservoir obstruction, or breakdown of the skin overlying the reservoir occurred. Serial computed tomographic scans documented control of the hydrocephalus and an increase in the thickness of the cortical mantle of the survivors. No mortality was associated with placement of the reservoir or its subsequent conversion, if necessary, to a ventriculoperitoneal shunt. However, only 7 of the 20 infants survived. On follow-up 3 to 5 years later, 2 of the 7 have normal intellectual and motor development. Two infants are normal intellectually, but have a motor deficit. The remaining 3 patients have both significant intellectual and motor developmental delay. The use of the reservoir is offered as a safe and effective alternative to repeated ventricular punctures, external ventricular drainage, or initial shunting. Aggressive management of hydrocephalus secondary to intraventricular hemorrhage may improve neurological function in some surviving neonates.

A study of cerebral palsy in multiple births was undertaken to test genetic involvement and assess the impact of the special conditions of pregnancy and parturition in these cases. Complete ascertainment of cerebral palsy in multiple gestations that occurred in Western Australia between 1956 and 1985 was obtained from the Western Australian Cerebral Palsy Register. There were 74 twins and 5 triplets. Data on sex, birth order, motor handicap, outcome in co-twins and triplets, zygosity, and pedigree information was obtained from the Register, hospital records, and, where possible, by interview of the parent(s) of the propositi. There was a significantly higher (P = 0.0026) concordance rate in MZ than in DZ twin pairs. However, pedigree studies showed no other relatives with a motor handicap similar to that of the propositi. This is consistent with a multifactorial cause in at least some of the cases. The sex ratio of affected twins was found to be 2.1 compared to 1.3 for singletons and all 5 affected triplets were boys. The trend of increasing sex ratio with increasing plurality was significant at the 1% level.

The adverse effects of vacuum therapy and intracavernous self-injection in patients on warfarin do not exceed the rate in the general urological population. These therapies appear to be safe in patients receiving warfarin.