Premature Infants with Intraventricular Hemorrhage and Perioperative Management of Neonatal Posthemorrhagic Hydrocephalus

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  • 未熟児脳室内出血と出血後水頭症の周術期管理

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  The most common cause of acquired infantile hydrocephalus is germinal matrix hemorrhage. In premature babies germinal matrix hemorrhage is seen in 7-30% of the population. In these children, 25-80% of them develop hydrocephalus.<br>  The severity of the hemorrhage and the development of hydrocephalus are correlated : Papile Grade I and II cases are mostly asymptomatic and their symptoms spontaneously regress. On the other hand, many Grade III and IV cases will suffer from hydrocephalus within four weeks. The immature brain is easily deformed because of its poor myelinization. As a result, marked enlargement of the ventricles will occur before the enlargement of the head circumference. The current perioperative management includes medical therapies with diuretics or steroids and surgical therapies such as repeated lumbar puncture, intermittent puncture through a cerebrospinal fluid reservoir, a ventricular subgaleal shunt, or continuous ventricular drainage through a PI catheter. If progressive enlargement of the ventricle is observed even after perioperative management, VP shunting is conducted when the weight of affected infant exceeds 2,000 g. Shunting, which is associated with complications such as malfunction and overdrainage of cerebrospinal fluid, is likely to cause intractable multilobulated hydrocephalus or isolated fourth ventricle hydrocephalus especially in cases of hydrocephalus following premature intraventricular hemorrhage. Future psychomotor developmental difficulty is attributed to the severity of the hemorrhage and peripartum problems rather than the hydrocephalus. In cases of neonatal posthemorrhagic hydrocephalus from prematurity, perioperative management is a critical factor that determines the prognosis of the affected infants.

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