Early external ventricular drainage for the treatment of premature/low-birth weight neonates with germinal matrix intraventricular hemorrhage

Abstract

Objective To observe the clinical efficacy of early external ventricular drainage (EVD) for the treatment of premature and/or low-birth weight neonates with germinal matrix intraventricular hemorrhage (GM-IVH). Methods A total of 14 children with GM-IVH grade Ⅲ followed up for more than 24 months and admitted to the Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University from January 2013 to February 2014 were enrolled retrospectively. All children were treated with emergent lateral ventricle external drainage for continuous drainage of cerebrospinal fluid after the definite diagnosis. The closed cerebrospinal fluid (CSF) drainage system was applied to prevent secondary intracranial infection. Results The mean EVD time of 14 children was 11.9±1.7 d, the volume of CSF drainage was 33.0±12.9 ml/d, and the intraventricular pressure (IVP) was controlled under 50 mmH2O. The intraventricular hemorrhage disappeared in all cases after EVD. The examination at 2 month after the removal of external ventricular drainage in 14 children, the ventricular system continued to expand in 8 cases. Then the ventriculo-peritoneal shunt (VPS) was performed. At 2 months after VPS, the ventricular system was reduced. After EVD, 6 cases were followed up for 24 month, and the ventricular system was reduced. and none of them underwent VPS. Conclusion The early treatment of premature/low-birth weight neonates with GM-IVH may help to prevent the occurrence of hydrocephalus after bleeding and reduce the proportion of conducting VPS. Key words: Infant, premature; Infant, low birth weight; Intracranial hemorrhages; Cerebral ventricles; Hydrocephalus; Germinal matrix; External ventricular drainage; Ventriculoperitoneal shunt