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Severe intracranial hemorrhage and hydrocephalus in low-birthweight infants treated with CSF shunts

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The high-risk low-birth-weight newborn not uncommonly develops intracranial hemorrhage and intraventricular hemorrhage (ICH/IVH) from the immature state of the germinal matrix. Posthemorrhagic hydrocephalus may develop. Infants with small hemorrhages (grades I, II of Papile), with or without hydrocephalus have been shown to develop normally in 80%–90% of cases. There is limited information in the literature about the management and outcome of infants with more severe hemorrhages (grades III, IV of Papile), due to the dismal outlook as to their outcome in most centers. The current status and concerns as to the management of these infants is reviewed, and the aspects of neurosurgical and neonatal follow-up and outcome are described. A significant number of these infants have severe handicaps, which are primarily motor. However, a group of infants is noted who have normal intellectual performance despite varying degrees of motor handicaps: 18% have normal intellectual and motor development. In the current series predictors of poorest outcome are the presence of grade IV hemorrhage and/or seizures. The vast majority of the grades III and IV hemorrhages develop hydrocephalus that is a complex management issue for the neurosurgeon.

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  1. 1.

    Bejar R, Coen R (1985) Normal cranial ultrasonography in neonates. In: James HE, Anas NG, Perkin R (eds) Brain insults in infants and children. Grune & Stratton, San Diego New York, pp 99–112

  2. 2.

    Bejar R, Coen R (1985) Neonatal intracranial pathology and ultrasonography. In: James HE, Anas NG, Perkin R (eds) Brain insults in infants and children. Grune & Stratton, San Diego New York, pp 125–157

  3. 3.

    Bejar R, Curbelo V, Coen RW, James H, Gluck L (1980) Diagnosis and follow-up of intraventricular and intracerebral hemorrhages by ultrasound studies of infant's brain through the fontanelles and sutures. Pediatrics 66:661–673

  4. 4.

    Bejar R, Coen RW, Ekpoidia I, James HE, Gluck L (1985) Real time ultrasound diagnosis of hemorrhagic pathology in the posterior fossa of preterm infants. Neurosurgery 16:281–289

  5. 5.

    Boynton BR, Boynton CA, Merritt TA, Vaucher YE, James HE, Bejar RF (1986) Ventriculoperitoneal shunts in low birthweight infants with intracranial hemorrhage: neurodevelopmental outcome. Neurosurgery 18:141–145

  6. 6.

    De Vries LS, Dubowitz LMS, Dubowitz V, Kaiser A, Larty S, Silverman M, Whitelaw A, Wiglesworth JS (1985) Predictive value of cranial ultrasound in the newborn baby: a reappraisal. Lancet II:137–140

  7. 7.

    Frerebeau P, Guillen M, Privat JM, Benezech J (1982) Nontumoral hydrocephalus. In: Choux M (ed) Monographs in neurological science, vol 8. Karger, Basel, pp 209–212

  8. 8.

    James HE, Bejar R, Coen R, Gluck L, Manino F (1982) The management of the high risk newborn with intracranial hemorrhage and progressive hydrocephalus. Proceedings of the Annual Meeting of the American Society for Pediatric Neurosurgery. (Concepts in pediatric neurosurgery II) Karger, Basel New York, pp 89–103

  9. 9.

    James HE, Bejar R, Merritt A, Gluck L, Coen R, Manino F (1984) Management of hydrocephalus secondary to intracranial hemorrhage in the high risk newborn. Neurosurgery 14:612–618

  10. 10.

    James HE, Bejar R, Gluck L, Coen R, Merritt A, Manino F, Bromberger P, Saunders B, Schneider H (1984) Ventriculoperitoneal shunts in high risk newborns weighing under 2,000 grams: a clinical report. Neurosurgery 15:198–202

  11. 11.

    Lazzara A, Ahmann P, Dykes F, Brann AW, Schwartz J (1980) Clinical pedictability of intraventricular hemorrhage in preterm infants. Pediatrics 65:30–34

  12. 12.

    McComb JG, Ramos AD, Platzker ACG (1983) Management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant with a subcutaneous ventricular catheter reservoir. Neurosurgery 13:295–300

  13. 13.

    Marlin AE (1980) Protection of the cortical mantle premature infants with posthemorrhagic hydrocephalus. Neurosurgery 7:464–468

  14. 14.

    Pape KE, Blackwell RJ, Cusick G, Sherwood A, Housang MTW, Thorburn RJ, Reynolds EOR (1979) Ultrasound detection of brain damage in preterm infants. Lancet II:1261–1264

  15. 15.

    Papile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birthweights less than 1,500 grams. J Pediatr 92:529–534

  16. 16.

    Volpe JJ (1977) Neonatal intracranial hemorrhage: pathophysiology, neuropathology and clinical features. Clin Perinatol 4:77–79

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Correspondence to H. E. James.

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James, H.E., Boynton, B.R., Boynton, C.A. et al. Severe intracranial hemorrhage and hydrocephalus in low-birthweight infants treated with CSF shunts. Child's Nerv Syst 3, 110–113 (1987).

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Key words

  • Prematurity
  • Hemorrhage
  • Hydrocephalus
  • CSF shunt
  • Outcome