ABSTRACT
In summary, IVH is a frequent occurrence in premature infants and will continue to be seen in practice so long as neonatologists remain successful in keeping these very small babies alive. While the low-grade IVH's are typically self-limiting conditions, more profound hemorrhages can have devastating effects on the neonate and initiate a progressive chain of events leading to significant neurodevelopmental morbidity. Early diagnosis and prompt medical management can allow a significant number of children to avoid permanent ventriculoperitoneal shunting. While a large number of these children will require a VP shunt, careful optimization of the child's condition prior to shunting in conjunction with a meticulous surgical technique designed to decrease infection rate allows many of these children to lead essentially normal lives. A team approach involving obstetrical care directed towards prevention of early labor and avoidance of hypoxia and hypercapnia at delivery combined with aggressive management by the neonatologist and early neurosurgical consultation is leading to a more hopeful future for many of these infants.
Subject(s)
Cerebral Hemorrhage/diagnosis , Cerebral Ventricles , Infant, Premature, Diseases/diagnosis , Cerebral Hemorrhage/mortality , Cerebral Hemorrhage/therapy , Humans , Infant, Newborn , Infant, Premature, Diseases/mortality , Infant, Premature, Diseases/therapy , Risk Factors , Survival Rate , Ventriculoperitoneal ShuntABSTRACT
A case is presented in which a patient was placed on phenytoin following open depressed skull fracture. He subsequently was lost to follow-up, and then presented with several complaints, among them mutism, found to be related to phenytoin toxicity. There are no reports to date of this condition being caused by phenytoin. The issue is again raised of the risk versus benefits of long-term anticonvulsant prophylaxis following severe head injury.
