Authors: Molly Hubbard, MD; Leah Kann; Danielle Tran; Sara Ramel, MD; Stephen Haines, MD; Daniel Guillaume, MD (Minneapolis, MN)
Background: Intraventricular hemorrhage(IVH) in premature infants is a major cause of morbidity in neonates of very low birth weight(<1500g). The incidence of IVH in this cohort of patients has decreased from 50% to about 20% as of 2005, however the incidence of posthemorrhagic hydrocephalus(PHH) continues to be present in 25-50% of patients with IVH and is associated with long-term neurodevelopmental impairment and shown to increase cognitive and psychomotor delay. There is no consensus regarding timing or type of surgical intervention for treatment; with shunt or ventriculosubgaleal shunt(VSGS). We hypothesize that CSF removal with frequent ventricular reservoir taps results in improved two-year neuro-cognitive outcome compared to infrequent taps in premature infants with VSGS for PHH.
Methods: The surgery database containing all records of patients who underwent VSGS at a single institution between 2006-2014 was reviewed, and their birth weight, sex, IVH grade, age at VSGS placement, ventricle size at VSGS placement, maximum/minimum ventricle size, ventricle size at 2 years, number of VSGS taps, volume tapped at each event, cognitive scores at 2 years(Bayley scores) and history of shunt infection/malfunction/seizures were recorded in a secured database.
Results: There were 32 patients, 15 females (47%), with an average birth weight of 808 grams. 18(56.3%) had grade IV, 9 had grade III hemorrhage, 4 had grade II IVH and one with grade I IVH. 13 patients had their VSGS tapped at least one time. Average ventricular volume had no correlation with Bayley scores at 2 years(p= 0.489). Total volume tapped ranged from 2-105.5 cc over the lifetime of the VSGS. In a general linear model, total volume tapped correlated with Bayley scores at 2 years(p=0.025).
Conclusions: Total volume tapped during the lifetime of a VSGS leads to improved Bayley scores at two years of age. Ventricular size did not correlate with outcomes.