Comparison between Different Temporary Measures for Management of Post- Hemorrhagic Hydrocephalus in Premature Infants: A Systematic Review

Abstract

Abstract Background Germinal matrix hemorrhage and subsequent posthemorrhagic hydrocephalus are common among pre-term infants due to multiple factors including fragility of germinal matrix vasculature, swinging increases of arterial and venous pressure, periodic hypoxia, and high metabolic demand. Aim of the Work To compare between Ventricular access device (VAD) and Neuroendoscopic lavage (NEL) as temporary measures for management of posthemorrhagic hydrocephalus in premature infants in terms of incidence of permanent shunt placement, and post operative complications like infection. This will be done through a systematic review of literatures addressing this research question. Patients and Methods Our study included 13 observational studies (12 retrospective and 1 prospective) comparing ventricular access device insertion vs neuroendoscopic lavage in management of posthemorrhagic hydrocephalus in pre-term infants regarding the need for VP shunt insertion and post operative complications mainly post operative infection and malfunction of the temporary CSF diversion, most of the cases had germinal matrix hemorrhage G III-IV according to papille classification, the results showed that while the neuroendoscopic lavage group had lower rate of VP shunt insertion, they had higher rate of post operative complications mainly malfunction of CSF diversion (The incidence of post operative infection was similar in both groups). Results In this review while comparing the need for VP shunt insertion in both groups was somewhat simple, comparing complications on the other hand was problematic due to the heterogenicity between types of complications and the underlying comorbidities, with different follow up periods and most of the complications is not shared by both groups. Conclusion Based on our systematic review and other available data in the literature, the neuroendoscopic lavage may be the preferred intervention for management of posthemorrhagic hydrocephalus in preterm infants regarding the incidence of permanent VP shunt insertion, although it has higher rate of malfunction and no statistical difference in post operative infection compared with the ventricular access device group.