Posthemorrhagic Hydrocephalus

Premature infants who have had an intraventricular hemorrhage may develop posthemorrhagic hydrocephalus in the newborn period. 18 Hydrocephalus can progress during the initial hospitalization, in which case the infant is usually discharged with a ventriculoperitoneal shunt in place, or hydrocephalus may develop gradually following discharge. Such infants may present to an emergency department because of progressive hydrocephalus if unshunted, or shunt obstruction or infection. Infants with infection usually have nonspecific signs, such as poor feeding, lethargy, irritability, fever, and vomiting, similar to those of any other child with central nervous system infection. Infants with obstructed shunts most often have a tense fontanelle and a history of vomiting, although the infant usually does not appear particularly ill. A comparison of the current head circumference with the head circumference at discharge (if available) is helpful in evaluating for progressive hydrocephalus. A computed tomography scan may be necessary to properly evaluate the size of the ventricles. Empiric antibiotic therapy should be utilized whenever a shunt infection is suspected, pending culture reports. Shunt infections usually require removal of the foreign body, although successful treatment without removal has been reported for Staphylococcus epidermidis infections. For both shunt infections and hydrocephalus, neurosurgical consultation is required.

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