ABSTRACT
STUDY OBJECTIVE: To report a 9-year experience with the treatment of posthemorrhagic hydrocephalus (PHH) with the use of an easily inserted external ventricular drain. DESIGN: A case series with a retrospective review of hospital records and cranial ultrasound results, from 1981 through 1989, in all infants with PHH. INTERVENTION: A previously defined method of identification and bedside management of PHH was applied. If infants reached 2 kg of body weight and PHH recurred, a ventriculoperitoneal shunt was inserted. RESULTS: A total of 70 procedures were performed in 24 patients, and all were associated with a decrease in head circumference and ventricular size on ultrasound scan. One infection occurred, and only 12 infants required a ventriculoperitoneal shunt. CONCLUSIONS: This technique compared favorably with other methods of intervention to avoid early placement of a ventriculoperitoneal shunt in preterm infants and offered the advantage of consistently decreasing ventricular size. A multicenter-controlled trial will be needed to compare the safety and efficacy of therapies for PHH.
Subject(s)
Catheters, Indwelling/standards , Cerebral Hemorrhage/complications , Cerebral Ventricles , Drainage/methods , Hydrocephalus/therapy , Infant, Premature , Body Weight , Cephalometry , Cerebral Hemorrhage/classification , Cerebral Hemorrhage/diagnostic imaging , Cerebrospinal Fluid Shunts , Drainage/instrumentation , Drainage/standards , Follow-Up Studies , Gestational Age , Humans , Hydrocephalus/diagnostic imaging , Hydrocephalus/etiology , Infant, Newborn , Recurrence , Retrospective Studies , Treatment Outcome , UltrasonographyABSTRACT
The authors present quantitative and qualitative techniques for respiratory airflow measurement and discuss the possible clinical applications and limitations of these methods.
Subject(s)
Infant, Newborn , Monitoring, Physiologic , Pulmonary Ventilation , Respiratory Function Tests/instrumentation , Apnea/diagnosis , Body Temperature , Carbon Dioxide , Heart Rate , Humans , Infant, Newborn, Diseases/diagnosis , Infant, Premature, Diseases/diagnosis , Respiratory Function Tests/methods , Respiratory Tract Diseases/diagnosisABSTRACT
Ventricular dilation following periventricular-intraventricular hemorrhage can be managed without ventriculoperitoneal shunting in most cases. Twenty-six patients who had periventricular-intraventricular hemorrhage with subsequent ventricular dilation were examined at 1 year of age for neurodevelopmental outcome and hydrocephalus. As previously reported, ventricular dilation may be divided into two groups: ventriculomegaly and posthemorrhagic hydrocephalus. Fourteen patients with ventriculomegaly were followed up with serial ultrasound observations only, and 12 patients with posthemorrhagic hydrocephalus had temporary drainage of ventricular fluid. Only three patients with posthemorrhagic hydrocephalus required ventriculoperitoneal shunting in the neonatal period. Neurodevelopmental abnormalities were found in eight infants who had posthemorrhagic hydrocephalus and two who had ventriculomegaly. Six of these infants had intraparenchymal injury demonstrated by ultrasound, five as a result of the original hemorrhage and 1 by infection. A single infant with posthemorrhagic hydrocephalus, discharged from the hospital with stable ventricular size, developed hydrocephalus and neurodevelopmental delay after the neonatal period. This reversed with ventriculoperitoneal shunting at 1 year of age. It is suggested that even in patients developing ventricular dilation following periventricular-intraventricular hemorrhage, it is the primary intraparenchymal injury that is responsible for subsequent morbidity. Thus, provided serial reevaluations are possible, an expectant management of ventricular dilation is justified.
Subject(s)
Cerebral Hemorrhage/complications , Cerebral Ventricles/pathology , Cerebrospinal Fluid Shunts , Dilatation, Pathologic/etiology , Follow-Up Studies , Humans , Hydrocephalus/etiology , Infant , Nervous System Diseases/etiology , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Seventy-six premature infants with clinical apnea, bradycardia, or cyanosis were studied with polygraph recordings of heart rate, nasal thermistor detection of airflow, and impedance pneumography. Pathologic apnea was defined by cessation of breathing for greater than 20 s or less than 20 s with bradycardia (heart rate, less than 100 beats per minute). Apnea was classified as central, obstructive, or mixed. Four hundred thirty-three apnea episodes were demonstrated: 238 (55.0%) were central, 53 (12.2%) showed obstructive apnea, and 142 (32.8%) were mixed. Fifty-two infants (68.5%) demonstrated some degree of obstructive apnea, while 24 infants (31.5%) had central apnea only. Bradycardia did not occur in any patient unless preceded by apnea. In premature infants, a significant percentage of apnea was associated with airway obstruction.
Subject(s)
Airway Obstruction/complications , Apnea/complications , Bradycardia/complications , Infant, Premature, Diseases/complications , Asphyxia Neonatorum/complications , Humans , Infant, Newborn , Respiratory Distress Syndrome, Newborn/complicationsABSTRACT
A noninvasive method for recording central and obstructive apnea with bradycardia is described. A polygraphy was used to record impedance pneumography, heart rate, and air flow with a nasally positioned thermistor. Episodes of apnea both central and obstructive were measured. In addition, episodes of bradycardia were recorded and the relationship to respiratory events documented. The application of the method to 12 patients with 13 clinical diagnosis for observed episodes demonstrated that the clinical diagnoses were inaccurate in 10 of 13. The method improved diagnoses by detecting apnea, both central and obstructive, not detected by the use of routine monitoring.
