Shunt Outcomes of Post-Hemorrhagic Hydrocephalus

Intraventricular hemorrhage and post-hemorrhagic hydrocephalus remain a leading cause of
mortality and long-term morbidity in premature infants. The two most common temporary
cerebrospinal fluid (CSF) diversion procedures are the ventriculosubgaleal shunt (SGS) and an
implanted ventricular reservoir (RES) for intermittent CSF removal. These methods are
physiologically very different and their comparative effectiveness in treating hydrocephalus
and possibly reducing the need for an eventual permanent CSF shunt is currently not known.
The goal of this pilot study is to obtain information critical for planning and executing a
future randomized trial comparing SGS and RES. Specifically, this pilot study will establish
inclusion criteria, define the primary outcome, and standardize the interventions in
preparation for initiating a comparative trial between the SGS and RES procedures. In
addition, the importance of examining the neurodevelopmental outcomes for these patients has
been recognized within the neurosurgical and neuropsychological settings. Therefore, the
scope of this study has been extended to include an examination of the neurodevelopmental
outcomes at 18 to 22 months and at 36 to 42 months in patients who undergo BSID-III testing
at their clinical centers.

Inclusion Criteria:

- premature neonates with birth weights less than 1500 grams

- Grade III or IV intraventricular hemorrhage

- Fronto-occipital horn ratio greater than or equal to 0.50

Exclusion Criteria:

- Less than 72 hour life expectancy from other medical problems