[Results of early external ventricular diversion in posthemorrhagic ventricular dilatation in the newborn].
OBJECTIVE
The authors report the outcome of early treatment with long-term external ventricular drainage (EVD) of progressive post-hemorrhagic ventricular dilatation (PPHVD), following peri-intraventricular hemorrhage (PIVH) in a population of preterm newborns.


METHODS
Neonatal Intensive Care Unit (NICU) of a Children's Hospital.


METHODS
Twenty-one preterms of 29.6 +/- 2.4 weeks of gestational age, weighing at birth 1443 +/- 445 g, mechanically ventilated, submitted to early EVD because of PPHVD following PIVH of III (n 11) e IV (n 10) grade.


METHODS
PPHVD was diagnosed on the basis of US and TC findings. An external liquoral drainage suitable, for its technical characteristics, to be maintained for a long period of time and peculiar anesthesiologic, intra and postoperative treatments were utilized.


RESULTS
EVD was placed at 21 +/- 5.8 days of life and maintained for 40 +/- 16 days. In all cases reduction of ventricular size was observed. One case (5%) developed liquoral infection and recovered with antibiotic therapy. No obstruction or dislocation of the ventricular catheter occurred. During EVD 3 patients (14%) died because of respiratory complications. After the normalization of cerebrospinal fluid (CSF), a "permeability test" was performed to assess the canalization of the liquoral system. Seven patients (33.5%) underwent ventriculo-peritoneal shunt (VPS) and 11 (52.5%) became shunt-free.


CONCLUSIONS
Our results indicate that long-term use of EVD has a low risk of complications, avoids the need for transcutaneous tips and allows monitoring of CSF characteristics. Furthermore EVD protects the brain from liquoral hypertension, while waiting for a possible recurrence of natural CSF circulation, and is associated with a low number of definitive VPS.
Massone
M L
ML
Servizio di Anestesia e Rianimazione, Istituto G. Gaslini, Genova.
Cama
A
A
Leone
D
D
Pellas
E
E
Vallarino
R
R
Carini
S
S
Andreussi
L
L
D002543:Cerebral Hemorrhage / Q000150:complications*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000601:surgery*; D008297:Male; D014696:Ventriculostomy
Risultati della derivazione ventricolare esterna precoce nella dilatazione ventricolare postemorragica del neonato.