Abstract
Background: Removal of cerebral spinal fluid (CSF) is the common treatment of post hemorrhagic ventricular dilatation (PHVD) in newborn infants. Puncture from a subcutaneous ventricular catheter reservoir (SVCR) allows easy CSF removal with minimal discomfort for the patient.Aims: To assess changes in cerebral oxygenation and hemodynamics after serial CSF removal from a SVCR in infants with PHVD.Methods: 6 infants (GA 216–258 days, BW 1490–2901 gram) were included for this study. These patients were studied during CSF drainage at day 1, 3 and 7 after SVCR placement. The amount of CSF removal was 5.5–9.6 ml/kg. Changes in concentration of oxyhemoglobin (ÄcO2Hb) and deoxyhemoglobin (ÄcHHb) were continuously measured using near infrared spectrophotometry. The difference in ÄcO2Hb and ÄcHHb, indicated as ÄcHbD, represents changes in cerebral blood oxygenation. Concentration changes in total hemoglobin (ÄctHb), calculated as the sum of ÄcO2Hb and ÄcHHb, reflects changes in cerebral blood volume. Changes in cHbD and ctHb were calculated between t=0 (start of CSF removal) and at 15, 30 and 60 minutes after CSF removal. Changes in mean cerebral blood flow velocity (ÄCBFV) in the internal carotid artery were intermittently measured using Doppler ultrasound. Physiologic variables (heart rate, arterial oxygen saturation, respiration rate and arterial blood pressure) were recorded. Results: Values are median (interquartile range). * significant changes (p <0.05, Wilcoxon-signed ranks test). There were no significant changes in physiological parameters.Conclusion: CSF removal from a SVCR results in improvement of cerebral perfusion, particularly the first day after SVCR placement. Cerebral blood oxygenation is only significantly increased at the day of SVCR placement. These changes are probably related to a reduction in intracranial pressure.
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