Abstract 2013

A nine-year retrospective case review was performed to evaluate the us of subcutaneous ventricular catheter reservoirs (VCR) to treat posthemorrhagic hydrocephalus (PHH) in preterm infants. Infants were hospitalized in the neonatal intensive care unit from January 1989 to December 1997. During this period, forty-eight VCR were placed in 43 preterm infants: mean gestational age was 28 3/7 wks (24 5/7 to 35 3/7 wks), and mean birth weight of 1140 g (620 to 2055 g).

VCR were placed at a mean postnatal age of 28.5 days (6 to 132 days), mean postconceptional age of 32 3/7 wks (27 4/7 to 47 6/7 wks), and mean body weight of 1490 g (820 to 3110 g). The mean duration of VCR tapping was 55.4 days (10 to 207 days).

Complications were observed in twenty patients, 55 % (11/20) being extremely low birth weight infants (ELBWI). Ventriculitis rate was 23%. One patient died because of a not-VCR-related complication.

A permanent arrest of the hydrocephalus, without any further therapy, was observed in six patients (14 % of surviving patients). In thirty-six infants a ventriculo-peritoneal (VP) shunt was placed. Twenty-one percent of the patients exhibited a normal neurological assessment of outcome at 12 and 24 months of corrected gestational age. Fifty-six percent had a mild or moderate handicap. Severe neurological impairment was present in 23% of the patients. A poor outcome was present in infants that had periventricular hemorrhage and/or periventricular leukomalacia.

Conclusions: This study reports on the largest population of preterm infants including ELBWI (46.5 % of total patient population) treated with VCR. Its use was not free of complications. However, this procedure allowed long-term CSF-tapping, precluded the necessity of VP shunts in some infants, and permitted in others definitive VP shunt placement under more favourable conditions.