THE TREATMENT OF HYDROCEPHALUS IN PRETERM INFANTS WITH INTRAVENTRICULAR HEMORRHAGE

The hospital charts and clinical course of forty-one patients requirin g one or more ventricular drainage procedures for hydrocephalic compli cations of neonatal intraventricular haemorrhage were evaluated retros pectively. All drainage procedures were performed on patients with int raventricular haemorrhage with ventricular dilatation (Grade III [25 p atients]) and intraventricular and intraparenchymal haemorrhage (Grade IV [16 patients]) who were medical management failures. Twenty-six ve ntricular reservoirs (Rickham or McComb reservoirs) were placed in neo nates weighing less than 1500 grams, allowing for a safe but intermitt ent ventricular access. Eighteen of these reservoirs were subsequently converted to ventriculoperitoneal shunts. Thirty-two percent of the p atients incurred a shunt and/or reservoir infection and 59% required a shunt revision during the first year of life. There was no mortality related to the neurosurgical interventions. These results compare favo rably with the published literature. No grade IV patients achieved a n ormal functional level, while 10 grade III patients did. The incidence of severe developmental delay (44% versus 28%) and death (38% versus 12%) was greater in the grade IV than the grade III patients.The place ment of ventricular reservoirs is acceptable as an alternative to the early placement of ventriculo-peritoneal shunts. This approach may red uce the incidence of shunt infection as well as noninfectious shunt co mplications.