Early treatment of posthemorrhagic hydrocephalus in low-birth-weight infants with valveless ventriculoperitoneal shunts.

The surgical treatment of posthemorrhagic hydrocephalus (PHH) in low-birth-weight infants (LBWI) is debated. In a few cases, hydrocephalus progresses rapidly and requires early drainage, but valves and ventriculostomy have a high rate of complications in the early phase. Temporary valveless shunt (VLS) is proposed as an alternative treatment of acute PHH in LBWI. Thirteen infants with PHH, weighing less than 2,000 g at birth, were treated with VLS, which was systematically converted into a valve-regulated shunt (VRS) after a few weeks; during the same period, 27 others were treated with VRS initially. The use of VLS presented significantly more shunt obstructions, but not more shunt infections, than VRS. Although placement of VLS was performed earlier, and in smaller babies than VRS, the outcome after a mean 9.1-year follow-up period was comparable in both groups, and only shunt infection was correlated with a poor outcome. We conclude that VLS is a valuable treatment of rapidly evolving PHH in LBWI.