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Child's Nervous System
Published in: Child's Nervous System 6/2011

01-06-2011 | Technical Note

Posthemorrhagic hydrocephalus in very low birth weight infants—a new gentle surgical technique for external ventricular drainage

Authors: Elke Januschek, Lisa Singh Machado, Barbara Steinthal, Peter T. Ulrich

Published in: Child's Nervous System | Issue 6/2011

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Abstract

Objective

The germinal matrix hemorrhage in premature infants is related to the immaturity of the subependymal vascular bed. Posthemorrhagic ventricular dilation (PVD) in extremely low birth weight infants (ELBI) is a medical challenge and is associated with a high risk of long-term disability. Our aim was to find a safe and gentle surgical technique for external ventricular drainage implantation for this patient population.

Patients and methods

We implanted eight external ventricular drainages in ELBI with birth weights ranging from 479 to 884 g (24 to 27 weeks gestational age) and a grade III to IV hemorrhage, who developed a PVD soon after birth. A replacement of the drainage was required three times in one infant with a birth weight of 479 g. Due to the subcutaneous tunneling and drawing of the catheter through the sleeve, the skin contact remains slight, and thus, infections are avoided.

Results

There were no complications during the procedures which can also be carried out in the neonatal intensive care unit. Only in one case (479 g birth weight and severe concomitant diseases) was an infection observed, though the origin was most likely abdominal. In the same case, a temporary leakage was treated by suture. This patient died of non-neurological complications related to the patient's prematurity. Three of the five preterms were shunted over time.

Conclusions

Although there is only a small number of extremely low birth weight infants with posthemorrhagic hydrocephalus who were treated with this technique, our findings suggest that this method is very safe and useful. It reduces the risk of infection and cerebrospinal fluid leaks and might be a better alternative to serial lumbar or transfontanel punctures in extremely low birth weight infants for bridging the first weeks of life.
Literature
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Pignotti MS (2008) Extremely preterm birth: recommendations for treatment in European countries. Arch Dis Child Fetal Neonatal Ed 93(6):F403–F405PubMedCrossRef
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Tommiska V, Heinonen K, Lehtonen L, Renlund M, Saarela T, Tammela O, Virtanen M, Fellman V (2007) No improvement in outcome of nationwide extremely low birth weight infant populations between 1996–1997 and 1999–2000. Pediatrics 119:29–36PubMedCrossRef
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Murphy BP, Inder TE, Rooks V, Taylor GA, Anderson NJ, Mogridge N, Horwood LJ, Volpe JJ (2002) Posthaemorrhagic ventricular dilatation in the premature infant: natural history and predictors of outcome. Arch Dis Child Fetal Neonatal Ed 87:F37–F41PubMedCrossRef
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Adams-Chapman I, Hansen NI, Stoll BJ, Higgins R (2008) Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion. Pediatrics 121(5):e1167–e1177PubMedCrossRef
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Horinek D, Cihar M, Tichy M (2003) Current methods in the treatment of posthemorrhagic hydrocephalus in infants. Bratisl Lek Listy 104(11):347–351PubMed
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Ventriculomegaly trial group (1990) Randomised trial of early tapping in neonatal posthaemorrhagic ventricular dilatation. Arch Dis Child 65(1):3–10CrossRef
Metadata
Title
Posthemorrhagic hydrocephalus in very low birth weight infants—a new gentle surgical technique for external ventricular drainage
Authors
Elke Januschek
Lisa Singh Machado
Barbara Steinthal
Peter T. Ulrich
Publication date
01-06-2011
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 6/2011
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-011-1413-1

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