Abstract
Eighteen preterm infants with severe progressive post-hemorrhagic hydrocephalus (PPH) following IVH were managed with serial lumbar punctures (LP) according to the following protocol. Daily serial LP with measurement of opening and closing pressure (OP,CP) were performed for no more than four weeks. Sufficient CSF was removed with each LP to lower OP by half. If OP became normal (≤ 80 mm H2O) and remained so for two successive days, LP was deferred for 48 hours and then repeated. If OP remained ≤ 80 mm H2O LP management was discontinued and the patient observed. If hydrocephalus progressed after discontinuation of LP or symptoms of increased intracranial pressure developed during LP management, shunt was effected.
Of the 18 infants thus far studied, 11 responded to LP management. OP in 10 of the 11 was ≤ 80 mm H2O by three weeks; none of the non-responders demonstrated OP ≤ 80 mm H2O prior to three weeks of therapy (p=0.0002). Initial CSF protein and sugar and response of CSF protein and sugar to LP were not predictive of response.
In conclusion, attainment of OP of ≤ 80 mm H2O for 3 successive days within a 21 day period of serial LP management is highly predictive of PPH response to LP management.
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Lazzara, A., Ahmann, P., Silverboard, G. et al. 1588 PROGRESSIVE POSTHEMORRHAGIC HYDROCEPHALUS: FACTORS PREDICTING RESPONSE TO LUMBAR PUNCTURE MANAGEMENT. Pediatr Res 15 (Suppl 4), 708 (1981). https://doi.org/10.1203/00006450-198104001-01605
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DOI: https://doi.org/10.1203/00006450-198104001-01605
