Acetazolamide and furosemide for posthemorrhagic hydrocephalus of the newborn

The authors evaluated the efficacy of acetazolamide (ACZ) and furosemide (F UR) in avoiding ventricular shunting procedures in preterm infants with pos themorrhagic hydrocephalus (PHH) and increased intracranial pressure (ICP), Preterm infants were screened for PHH (defined as ventriculomegaly [VM] an d increased ICP measured with the Ladd fiberoptic monitor). PHH infants wer e randomized to ACZ and FUR treatment or serial lumbar puncture (LP) and mo nitored until not receiving medications or having undergone shunting. Of 69 infants with IVH screened for the study, 39 never developed VM, 14 develop ed VM, without increased ICP, and 16 developed PHH. Ten PHH infants were ra ndomized to ACZ and FUR treatment and six to serial LP, Nine (90%) of the 1 0 infants assigned to the ACZ and FUR group avoided shunting. Nephrocalcino sis developed in a significant proportion of treated infants. Three (50%) o f the six Up group infants did not require shunting procedures (P = 0.118), The authors conclude that ACZ and FUR therapy is useful in the treatment o f preterm infants with PHH. Because a significant number of infants treated with both ACZ and FUR developed nephrocalcinosis, close monitoring for inc reased calcium excretion in the urine, or use of ACZ without FUR, is advise d. (C) 1999 by Elsevier Science Inc. All rights reserved.