N/IICU Clinical Pathway for the Treatment of Preterm Infants with Post-hemorrhagic Hydrocephalus

  • Exclusions
    • Congenital Hydrocephalus
    • Myelomeningocele
  • History and physical
  • Laboratory, imaging studies
  • Neurosurgery consult
  • Daily head circumference
  • BW < 1500 g, Grade III or IV IVH, > 72 hour life expectancy
  • FOR or FTHR ≥ 0.55
  • And, any two:
    • Bradycardia, split sutures, bulging fontanelle
External Drain
Reservoir
Ventricular Shunt
Observe
  • Unable to place shunt due to other clinical concerns (e.g., active meningitis or other infection)
  • Evaluation for Infection
  • < 1500 g
  • Unfavorable abdomen
> 1500 g
  • Head US weekly for 3 weeks
  • Daily head circumference
  • If rate of head growth > 1.5 cm/week or bradycardia
    Review Treatment Criteria
  • If stable head circumference growth monthly; then HUS monthly

 

Ongoing Observation
Observe
Continue Tapping
Shunt/ETV
  • Head circumference x3 days
  • Daily electrolytes x3 days
  • MRI 1 day post-op
Posted: November 2015
Revised: August 2022
Authors: J. Flibotte, MD; G. Heuer, MD; L. Heimall, MSN; D. Munson, MD; T. Flanders, MD; H. Morris, PA