The treatment of hydrocephalus in preterm infants with intraventricular haemorrhage.

The hospital charts and clinical course of forty-one patients requiring one or more ventricular drainage procedures for hydrocephalic complications of neonatal intraventricular haemorrhage were evaluated retrospectively. All drainage procedures were performed on patients with intraventricular haemorrhage with ventricular dilatation (Grade III [25 patients]) and intraventricular and intraparenchymal haemorrhage (Grade IV [16 patients]) who were medical management failures. Twenty-six ventricular reservoirs (Rickham or McComb reservoirs) were placed in neonates weighing less than 1500 grams, allowing for a safe but intermittent ventricular access. Eighteen of these reservoirs were subsequently converted to ventriculoperitoneal shunts. Thirty-two percent of the patients incurred a shunt and/or reservoir infection and 59% required a shunt revision during the first year of life. There was no mortality related to the neurosurgical interventions. These results compare favorably with the published literature. No grade IV patients achieved a normal functional level, while 10 grade III patients did. The incidence of severe developmental delay (44% versus 28%) and death (38% versus 12%) was greater in the grade IV than the grade III patients. The placement of ventricular reservoirs is acceptable as an alternative to the early placement of ventriculo-peritoneal shunts. This approach may reduce the incidence of shunt infection as well as noninfectious shunt complications.