Post-Hemorrhagic Hydrocephalus in Pre-Term Infants Clinical Pathway — N/IICU
Post-Hemorrhagic Hydrocephalus in Pre-Term Infants Clinical Pathway — N/IICU
Considerations for Transferring a Patient to CHOP for Treatment
Referring neonatologists may consider consultation with CHOP Neonatology and Neurosurgery for infants with post-hemorrhagic hydrocephalus if there is unacceptable ventricular growth, despite local management.
Consider Reservoir if the Neonate Meets the Following Criteria
| Birth Weight | < 1500 g > 1500 g consider VP shunt |
|---|---|
| Intraventricular Hemorrhage | Grade III or IV |
| Life Expectancy | > 72 hours |
| FOR | ≥ 0.55 (moderate hydrocephalus) or an increase in FOR of 0.1 |
PLUS at least 2 of the following:
| Bradycardia | ≥ 3 episodes requiring intervention or lasting more than 30 seconds per 24 hours not explained by other cause |
|---|---|
| Split Sutures | > 2 mm (roughly a fingertip) measured 1 cm from the fontanelle |
| Bulging Fontanelle | Above the level of the bone while calm, sitting |
To Initiate a Neurosurgical Consultation or Transfer of Patient for Care
- Call CHOP Transport Communications Center at 1-800-590-2160 to generate an MRN for the patient and initiate consult.
- Discuss details with neonatology medical command physician.
- Neonatology will contact neurosurgery, especially if patient is known to them via previous phone consult.
- Timing of transfer based on patient needs, referring preferences and timing of planned interventions.
Transferring Radiology Images
- Referring physicians should obtain a cranial ultrasound
- Measuring Ventricular Size on Cranial Ultrasound
The CHOP specialist should order a second read for outside films in EPIC. Instructions for transferring images for a second opinion can be found on the Radiology internet site.