Ventriculo-Peritoneal Shunt as an Initial Treatment Modality for Premature Infants with Hydrocephalus

Abstract

The use of a ventriculo-peritoneal (V-P) shunt as an initial treatment modality in premature infants with hydrocephalus is still controversial. During a 3-year period, we treated seven infants (four males and three females), using a V-P shunt without prior placement of external ventricular drainage or a subcutaneous reservoir. The gestational age at birth ranged from 24 to 34 weeks (mean, 27.6 weeks). The weight at surgery ranged from 1060 to 2340 g (mean, 1580 g). Four infants had severe respiratory distress syndrome (RDS). Hemorrhage was revealed in two while there was no ultra-sonograpic or computed tomography (CT) evidence of hemorrhage in the other two. The cause of hydrocephalus or an associated disorder in the remaining three infants was meningitis, aqueductal stenosis and myelomeningocele, respectively. The timing of shunt placement was 1-121 days (mean, 49.8 days) after birth. A pediatric Hakim ball valve was used in five infants and a Mini-LPV (diaphragm valve) was used in one infant. No valve was connected in the remaining infant. Shunt revision was not needed in three infants. Infection occurred in only one case; the infant with postmeningitic hydrocephalus. The other six developed neither infection nor skin erosion. Psychomotor development was rated as normal in five, retarded in one (postmeningitic) and disabled in one (posthemorrhagic). The present results suggest that a V-P shunt can be used as the surgical procedure of first choice in treating premature infants with hydrocpephalus without serious complications.