Management of post-haemorrhagic hydrocephalus in premature infants

• Intraventricular haemorrhage occurs in preterm very low birth weight babies.
• Post-haemorrhagic hydrocephalus is the most common neurological complication of preterm birth and can result in severe long-term sequelae.
• Temporising measures are undertaken until more definitive intervention can be tolerated.
• Temporising measures include LPs, EVD or VAD insertion and ventriculosubgaleal shunts.
• The optimum time and technique of intervention in this patient group is still unclear.

Post-haemorrhagic hydrocephalus (PHH) is the most common neurological complication of preterm birth and can result in severe and life-long psychomotor and cognitive sequelae. Cerebrospinal fluid diversion is often required but the optimum time for intervention is unclear. Numerous neurosurgical procedures exist to temporise PHH but it is not clear which is the optimum method. Approximately 15% of preterm infants who suffer intraventricular haemorrhage (IVH) will require permanent cerebrospinal fluid diversion with a ventriculoperitoneal shunt. It is likely that earlier intervention may result in reduced neurological disability and ventriculoperitoneal shunt dependency. In this review we discuss the current methods of PHH management.