N/IICU Clinical Pathway for the Treatment of Preterm Infants with Post-Hemorrhagic Hydrocephalus
- Exclusions
- Congenital hydrocephalus
- Myelomeningocele
- History and physical
- Laboratory, imaging studies
- Consult Neurosurgery
- Daily head circumference
- 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
Evidence
- Post-Hemorrhagic Ventricular Dilatation: Comparison of Management Pathways Among North American Level IV NICUs
- Measurement of Ventricular Size: Reliability of the Frontal and Occipital Horn Ratio Compared to Subjective Assessment
- Predictive Value of Cerebrospinal Fluid Parameters in Neonates with Intraventricular Drainage Devices
- Frontal and Occipital Horn Ratio: A Linear Estimate of Ventricular Size for Multiple Imaging Modalities in Pediatric Hydrocephalus
- The Frontal and Temporal Horn Ratio to Assess Dimension of Paediatric Hydrocephalus: a Comparative Volumetric Study
- Shunting Outcomes in Posthemorrhagic Hydrocephalus: Results of a Hydrocephalus Clinical Research Network Prospective Cohort Study
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