[Assessment and therapeutic possibilities in posthemorrhagic hydrocephalus of the newborn infant].

Internal hydrocephalus follows intraventricular hemorrhage in about 10%. Progression is directly related to the degree of hemorrhage. Several studies confirmed that cerebral damage may occur without an increase of intracranial pressure or head circumference. Assessment and therapeutic consequences depend entirely on sonographic and clinical criteria. In our series, 40 of 135 neonates with intraventricular hemorrhage developed internal hydrocephalus. Therapy was necessary in 35 children, 11 died. Serial lumbar punctures were the most frequent therapeutic approach in 70% of the children. 40% required a shunt, usually a ventriculo-peritoneal system. In this group the proportion of Grade III and IV hemorrhage was high. In 25% external drainage for one week was necessary. 10% were treated with acetazolamide and furosemide. By this therapy shunt placement could be avoided in 9 children (69.2%), in the group with Grade III hemorrhage. In addition it was possible to postpone shunting to the third month on the average. 25 children were followed-up. 40% were normal or had a mild developmental delay. 60% were seriously handicapped. Poor neurodevelopmental outcome was related directly to hemorrhage Grade III and IV, therefore to brain damage in the early phase. To prevent additional lesions it should be emphasized that in infantile hydrocephalus best long-term results have been obtained if the process was controlled early rather than later.