title: Posthemorrhagic hydrocephalus in extremely low birth weight infants: Ommaya reservoir vs. ventriculoperitoneal shunt.
abstract: OBJECTIVE
  The aim of this study was to analyze morbidity and initial surgery in infants with posthemorrhagic hydrocephalus (PHH) by comparing infants who were treated with a subcutaneous cerebrospinal fluid reservoir (Ommaya reservoir = CSF_R) with infants who primarily received a ventriculoperitoneal shunt (VPS).
  
  
  METHODS
  Inclusion criteria were infants born between January 2006 and June 2014 who had a diagnosis of intraventricular hemorrhage (IVH) and underwent surgical intervention for hydrocephalus.
  
  
  RESULTS
  Twenty-five infants, with a median gestational age (GA) of 26.5 (28 ± 4) weeks and a median birth weight (BW) of 980 g (1205 ± 837), were included. The median umbilical artery pH (UApH) was 7.30 (7.20 ± 0.25). The median Apgar score at 10 min was 8 (7.4 ± 2). Twenty-five peri- and postnatal adverse events were encountered preoperatively. The IVH grades were grade II (n = 1), grade III (n = 17), grade IV (n = 6), and unknown grade (n = 1). Primary treatment consisted of CSF_R (n = 18) or VPS (n = 7) placement. There was a statistically significant difference between the postnatal ages of infants with CSF_R (32.5 days; 42 ± 28) and infants with VPS (163 days; 161 ± 18). Furthermore, we found a difference regarding GA but not BW between both groups. Arrest of PHH with shunt independence occurred in two infants from the CSF_R group (11%).
  
  
  CONCLUSIONS
  In the present study, early insertion of CSF_R allowed stabilization of the infants and thus postponement of permanent VPS insertion. However, in a subgroup of patients, PHH develops over a more prolonged course, and VPS insertion can be performed initially without the need for CSF_R.
authors.affiliation: Klinik für Kinderchirurgie, Marienhospital Herne, St. Elisabeth Gruppe Rhein-Ruhr, Ruhr-Universität Bochum, Widumer Str. 8, D-44627, Herne, Germany, ralf-bodo.troebs@marienhospital-herne.de.
authors.forename: Ralf-Bodo
authors.initials: RB
authors.lastname: Tröbs
authors.forename: Volker
authors.initials: V
authors.lastname: Sander
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery*; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D062666:Vascular Access Devices; D017287:Ventriculoperitoneal Shunt / Q000379:methods*