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Post-Hemorrhagic Hydrocephalus in Pre-Term Infants Clinical Pathway – N/IICU

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

 
 
  • Exclusions
    • Congenital hydrocephalus
    • Myelomeningocele
 
 

N/IICU Team Assessment

  • History and physical
  • Laboratory, imaging studies
  • Consult Neurosurgery
  • Daily head circumference
 
 
 
 

Treatment Criteria

  • Grade III or IV Intraventricular Hemorrhage (IVH)
  • > 72 hr life expectancy
  • Fronto-Occipital Ratio (FOR) or Fronto-Occipital Horn Ratio (FTHR) ≥ 0.55
  • And ≥ 2 of the following:
    • Bradycardia, split sutures, bulging fontanelle
Does not initially meet treatment criteria
 
 
 
Observe
  • Continue to review Treatment Criteria
  • Head US (HUS) weekly for 3 wks
  • Daily head circumference
    • If stable head circumference growth for a month; then HUS monthly
 
 
 
 
 
 
Ventricular Shunt
Reservoir
External Drain
Current weight ≥ 1500 g
  • Current weight < 1500 g
  • Unfavorable abdomen
  • Unable to place shunt or reservoir due to other clinical concerns
    • e.g., active meningitis or other infection
  • Evaluation for Infection
 
 
 
 
Ongoing Observation
 
 
 
 
 
 
 
 
Observe
Continue Tapping
Shunt/ETV
  • Head circumference ×3 days
  • Daily electrolytes ×3 days
  • MRI per Neurosurgery
  • Consult Neurology
 
 

 

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