N/IICU Clinical Pathway for the Treatment of Preterm Infants with Post-hemorrhagic Hydrocephalus
- Related Pathway
- Exclusions
- Congenital Hydrocephalus
- Myelomeningocele
- History and physical
- Laboratory, imaging studies
- Neurosurgery consult
- Daily head circumference
- BW < 1500 g, Grade III or IV IVH, > 72 hour life expectancy
- FOR or FTHR ≥ 0.55
- And, any two:
- Bradycardia, split sutures, bulging fontanelle
External Drain
Reservoir
Ventricular Shunt
Observe
- Unable to place shunt due to other clinical concerns (e.g., active meningitis or other infection)
- Evaluation for Infection
- < 1500 g
- Unfavorable abdomen
> 1500 g
- Head US weekly for 3 weeks
- Daily head circumference
- If rate of head growth > 1.5 cm/week or bradycardia
Review Treatment Criteria - If stable head circumference growth monthly; then HUS monthly
Ongoing Observation
Observe
Continue Tapping
Shunt/ETV
- Head circumference x3 days
- Daily electrolytes x3 days
- MRI 1 day post-op
Posted: November 2015
Revised: August 2022
Authors: J. Flibotte, MD; G. Heuer, MD; L. Heimall, MSN; D. Munson, MD; T. Flanders, MD; H. Morris, PA
Authors: J. Flibotte, MD; G. Heuer, MD; L. Heimall, MSN; D. Munson, MD; T. Flanders, MD; H. Morris, PA
Evidence
- Measurement of Ventricular Size: Reliability of the Frontal and Occipital Horn Ratio Compared to Subjective Assessment
- Predictive Value of Cerebrospinal Fluid Parameters in Neonates with Intraventricular Drainage Devices
- Frontal and Occipital Horn Ratio: A Linear Estimate of Ventricular Size for Multiple Imaging Modalities in Pediatric Hydrocephalus
- The Frontal and Temporal Horn Ratio to Assess Dimension of Paediatric Hydrocephalus: a Comparative Volumetric Study