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

  • Neonates born at ≤ 32 weeks
  • Exclusions
    • Congenital Hydrocephalus, Myelomeningocele
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)
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