Protection of the cortical mantle in premature infants with posthemorrhagic hydrocephalus.

Premature infants weighing under 1500 g are now surviving because of technical and medical advances in the field of neonatology. Up to 70% of these babies will have intracranial hemorrhages. The management of posthemorrhagic hydrocephalus in these children with multiple other medical problems has thus become quite significant. This paper reports the results of the placement of a subcutaneous ventricular reservoir in 12 of these low birth weight infants in an attempt to protect their cortical mantle until their medical problems resolve and the risks and complications of shunting are acceptable. The infants were selected on the basis of clinically progressive hydrocephalus, multiple medical problems, and the failure of lumbar punctures to control the hydrocephalus. The placement of the reservoir was carried out in the neonatal intensive care unit and there were daily aspirations of cerebrospinal fluid. In all of the patients the hydrocephalus and increased intracranial pressure were controlled, with a stabilization of or an increase in the cortical mantle. Seven infants died from other problems associated with their prematurity. Seven required shunts when their medical problems resolved; one, now 1 year of age, has not required a shunting procedure.