Hydrocephalus Secondary to Intracranial Hemorrhage in Premature Infants

Wise, Burton L.; Ballard, Roberta A.

doi:10.1159/000119620

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…7,14 There are case reports of shunt failure attributed to high protein levels. 10,15,28 Taylor and Peter 24 recommended delaying shunt insertion in patients with PHH and low birth weight. They speculated that inserting a shunt prior to Day 35 of life has a higher risk of failure that "probably correlates with a high concentration of blood breakdown products in the cerebrospinal fluid during the first month after intra-ventricular hemorrhage."…”

Section: Discussionmentioning

confidence: 99%

Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with posthemorrhagic hydrocephalus

Fulkerson

Vachhrajani

Bohnstedt

et al. 2011

PED

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Object Premature, low-birth-weight infants with posthemorrhagic hydrocephalus have a high risk of shunt obstruction and infection. Established risk factors for shunt failure include grade of the hemorrhage and age at shunt insertion. There is anecdotal evidence that the amount of red blood cells or protein levels in the CSF may affect shunt performance. However, this has not been analyzed specifically for this cohort of high-risk patients. Therefore, the authors performed this study to examine whether any statistical relationship exists between the CSF constituents and the rate of shunt malfunction or infection in this population. Methods A retrospective cohort study was performed on premature infants born at Riley Hospital for Children from 2000 to 2009. Inclusion criteria were a CSF sample analyzed within 2 weeks prior to shunt insertion, low birth weight (< 1500 grams), prematurity (birth prior to 37 weeks estimated gestational age), and shunt insertion for posthemorrhagic hydrocephalus. Data points included the gestational age at birth and shunt insertion, weight at birth and shunt insertion, history of CNS infection prior to shunt insertion, shunt failure, shunt infection, and the levels of red blood cells, white blood cells, protein, and glucose in the CSF. Statistical analysis was performed to determine any association between shunt outcome and the CSF parameters. Results Fifty-eight patients met the study entry criteria. Ten patients (17.2%) had primary shunt failure within 3 months of insertion. Nine patients (15.5%) had shunt infection within 3 months. A previous CNS infection prior to shunt insertion was a statistical risk factor for shunt failure (p = 0.0290) but not for shunt infection. There was no statistical relationship between shunt malfunction or infection and the CSF levels of red blood cells, white blood cells, protein, or glucose before shunt insertion. Conclusions Low-birth-weight premature infants with posthemorrhagic hydrocephalus have a high rate of shunt failure and infection. The authors did not find any association of shunt failure or infection with CSF cell count, protein level, or glucose level. Therefore, it may not be useful to base the timing of shunt insertion on CSF parameters.

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Section: Discussionmentioning

confidence: 99%

Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with posthemorrhagic hydrocephalus

Fulkerson

Vachhrajani

Bohnstedt

et al. 2011

PED

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“…The surgical treatment of PHH has usually consisted of performing a shunt procedure several days or weeks after diagnosis, usually when the infants were 6 weeks to 6 months of age [2,9,19], The considerable delay while waiting for the bloody CSF to clear was based on the hope that the fluid would be less viscid, thus preventing obstruction. Despite such pre cautions.…”

Section: Resultsmentioning

confidence: 99%

“…In Lorber and Bhat'% [9] large series, obstruction occurred in 46% of patients, two-thirds of whom required more than one shunt revision. Wise and Bal lard [19] treated 7 infants; 3 of these infants needed multiple shunt revisions because of obstruction.…”

Section: Resultsmentioning

confidence: 99%

Early Surgical Intervention in Posthemorrhagic Hydrocephalus

Bada¹,

Salmon²,

Pearson³

1979

Pediatr Neurosurg

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10 premature infants were found to have posthemorrhagic hydrocephalus (PHH) over a 4-year period. All weighed less than 2,500 g. The diagnosis was established by ventricular puncture and ventriculogram. Ventriculo-peritoneal (V-P) shunt placement was done in each infant soon after establishing the diagnosis, while the cerebrospinal fluid (CSF) was bloody. The mean age of infants at surgery was 21.4 days (range 16–33 days). Shunt obstruction occurred in 3 infants and infection in 1. No other complication was observed. All infants improved markedly in the immediate postoperative period, especially respirator-dependent infants. All survived; preliminary follow-up revealed that 3 were severely retarded and 2 mildly retarded; 5 infants were normal. Our preliminary experience with early V-P shunt procedure in the treatment of PHH has been favorable and follow-up appears encouraging.

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“…Recently, intermittent reduction of CSF volume via a ventricular catheter reservoir (VCR) has become an accepted alter native or adjunct to the above therapies. Introduced in 1975 by Deonna et al [20] and later reported by Wise and Ballard [21], VCRs quickly became a safe and reasonable means by which cortical mantle thickness could be preserved while the elevated protein and cell counts in posthemorrhagic CSF became favorable for shunting. McComb et al [22] and Gaskill et al [23] have reported 20 and 38 infants, respectively, treated initially for PHH with a combination of serial LPs and VCRs.…”

Section: Introductionmentioning

confidence: 99%

Management of Posthemorrhagic Hydrocephalus in the Low-Birth-Weight Preterm Neonate

Brockmeyer¹,

Wright²,

Walker³

et al. 1989

Pediatr Neurosurg

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Over a period of 34 months from 1987 to 1990 we inserted ventricular catheter reservoirs (VCR) into 20 premature low-birth-weight infants who had developed progressive, symptomatic posthemorrhagic hydrocephalus following grade III or IV intraventricular hemorrhages. The mean estimated gestational age was 27.7 ±5.3 weeks and mean birth weight was 1,041 ±699 g. The ventricular catheter reservoirs were placed on day of life 30.7 ± 29.7 and tapped for a total of 3–34 days at varying frequencies and for varying volumes. Of the 20 patients, 4 died on days of life 25, 76, 88, and 187. There were two reservoir infections, both occurring in infants who eventually died. The 16 survivors have been followed from 2 to 24 months (adjusted age). Four (25%) remain shunt-free and 3 have undergone VCR removal. There have been two shunt infections in the 12 shunted patients; ten shunt revisions have been performed overall. At the time of last follow-up, 14 patients were old enough to undergo neurodevelopmental evaluation. Five patients (36%) were ‘normal’ on gross neurological screening examination, 5 (36%) had ‘mild developmental delay’ and 4 (28%) had ‘significant developmental delay’. We feel these data support the continued use of ventricular catheter reservoirs in the management of posthemorrhagic hydrocephalus and offer hope that some of these patients might remain shunt-free and most will have a normal or mildly delayed neurodevelopmental outcome.

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Hydrocephalus Secondary to Intracranial Hemorrhage in Premature Infants

Cited by 8 publications

References 4 publications

Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with posthemorrhagic hydrocephalus

Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with posthemorrhagic hydrocephalus

Early Surgical Intervention in Posthemorrhagic Hydrocephalus

Management of Posthemorrhagic Hydrocephalus in the Low-Birth-Weight Preterm Neonate

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