N/IICU Clinical Pathway for the Treatment of Preterm Infants with Post-hemorrhagic Hydrocephalus
- Neonates born at ≤ 32 weeks
- Exclusions
- Congenital Hydrocephalus, Myelomeningocele
-
History and Physical
-
Laboratory Studies
-
Neurosurgery consult
-
Daily Head Circumference
External Drain
Reservoir Placed
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
Observe
Continue Tapping
Surgeon Preference
Shunt/ETV
Clinical Observation
- Head circumference (x3 days)
- Daily electrolytes (x3 days)
- If ETV, then MRI (1 day post-op)
- BW < 1500 g, Grade III or IV IVH, > 72 hour life expectancy
FOR or FTHR ≥ 0.55
Measuring Ventricular Size on Cranial Ultrasound
And, any two
Bradycardia, split sutures, bulging fontanelle
Posted: November 2015
Reviewed: January 2020
Authors: J. Flibotte, MD; G. Heuer, MD; L. Heimall, MSN; A. Giaccone, MD; D. Munson, MD; T. Moyer-Fuchs, CRNP; K. Chambers, RN; H. Morris, PA
Authors: J. Flibotte, MD; G. Heuer, MD; L. Heimall, MSN; A. Giaccone, MD; D. Munson, MD; T. Moyer-Fuchs, CRNP; K. Chambers, RN; H. Morris, PA
Evidence
Related Links
- Nursing Procedure 10:4:a Intracranial Pressure Monitoring
- Nursing Standard 4:1:b Care of the Patient Requiring Placement of an Intracranial Pressure Monitoring Device & Monitoring of Intracranial Pressure
- Nursing Standard 5:4 Non-Pharmacologic Pain Management during Short-Term Procedures in Infants – Sucrose Administration