Advantages of delayed VP shunting in post-haemorrhagic hydrocephalus seen in low-birth-weight infants

The optimal timing of ventriculo-peritoneal (VP) shunt insertion in a neona te with post-haemorrhagic hydrocephalus (PHH) is uncertain. During the X-ye ar period from January 1989 to December 1996, 41 patients had VP shunts ins erted for PHH at Red Cross War Memorial Children's Hospital. Data on 36 pat ients were sufficient for review in order to determine whether the timing o f surgery in any way influenced the complication incidence of this interven tion. Nine of the 36 patients had a serious complication, either infection or mechanical shunt obstruction, during their initial hospital admission (e arly period). Nineteen patients had surgery performed before day 35 after b irth and all those with early complications were in this group. Seventeen p atients had surgery delayed until after day 35, and none of these patients had an early complication. In this study a higher complication incidence wa s noted when a VP shunt was inserted prior to day 35 (Chi-square test P<0.0 1). This most probably correlates with a high concentration of blood breakd own products in the cerebrospinal fluid during the first month after intra- ventricular haemorrhage.