The role of permanent invasive monitoring of intracranial pressure in the treatment of infants with posthaemorrhagic ventricular dilatation after intraventricular haemorrhage (case report).

Posthaemorrhagic ventricular dilatation (PHVD) is a major complication of intraventricular haemorrhages in very preterm infants. Posthaemorrhagic ventricular dilatation is associated with a high rate of disability, multiple impairments and adverse effects of shunt surgery for hydrocephalus. It may lead to an impaired neurological prognosis, caused by a raised intracranial pressure (ICP) and concomitant decreased cerebral blood perfusion. Therefore, early intervention to decrease the ICP may improve the long term outcome. Different treatment modalities have been studied, of which repetitive removal of cerebrospinal fluid (CSF) seems to be the only effective one. Studies performed in several institutions showed, that intermittent CSF drainage in very preterm infants with PHVD is an effective way to treat increased ICP and its negative effect on cerebral blood perfusion. The cut off point for CSF drainage is about 6.0 cm H(2)O ICP, as drainage below that level no longer results in improvement in perfusion. From this single case study it can be concluded, that in preterm infants with PHVD, repetitive CSF tapping from a ventricular access device guided by ICP measurements and ICP targeted treatment strategy is a useful technique for determining the frequency and volume of CSF removal. In neonatal intensive care units with poor capabilities and resources this is possible even by placing the simple intravenous single lumen catheter.