Newborn With

Hydrocephalus
Allegra Sardo
 WARD
HCU NEONATOLOGY: the baby presented with
hydrocephalus, polydactily, mild respiratory
distress and asphyxia
 Identity
Name: K
Age: 3 days ( born 07.08.2015 )
Sex: M
Address: Kauman Kebakkramat
Exam Date: 10.08.2015
 Anamnesis
Hydrocephalus, polydactily, mild respiratory
distress, asphyxia
The baby is fed with breast milk

Antropometry 1. Length 50 cm
2. Arm Circumference 8 cm
3. Head Circumference 52
4. Chest Circumference 28 cm
5. Weight 4600 gr
 Delivery History First delivery. The delivery
was a term and with breech presentation. The
mother went under caesarian procedure with no
complications. She had no amniotic fluid
leakage.
Family History

The mother was TORCH (+) [CMV and Rubeola]

DM (-), Asthma (-), Allergies (-), HT (-),
Cardiovascular Diseases (-).
 Physical Exam
GC Good
VS HR 152 x/mnt T 37.2 C RR 50 x/mnt
CN STATUS Eyes Open (+)
Loud Cry (-)
Active Movements (-) Ass: S3
CD STATUS HR 152 x/mnt
Noisy (-)
ADP (+)
CRT <2 Ass: no abnormalities
 NEUROLOGICAL STATUS
Sunset phenomenon (+)
Physiological Reflexes: Biceps +2/+2
Triceps +2/+2
Patella +2/+2
Achilleis +2/+2
Pathological Reflexes: Babinski -/-
Chaddock -/-
Gordon -/-
Oppenheim -/-
Meningeal Signs: Stiff neck
Brudzinski I-IV -/-
Kernig -/-
 RESPIRATORY STATUS RR 58 x/mnt
Retractions (+)
Cianosis (-)
Air Entry (+)
Nasal Respiration (+)
Ass: DS2

MILD RESPIRATORY DISTRESS

 GI STATUS Meconium (-)
Defecation (-)
Vomiting (-)
Anus (+)
INFECTIOUS STATUS T 37.2 C Ass: no abn
LAB
HB 14.4 g/dl EOS 1,2%
HTC 44% BAS 0.3%
LCE 26.6 ribu/ul NEU 75.3%
PLTs 182 ribu/ul LNF 16.5%
MCV 104 /um
MCH 33.9 pg GLC 52 mg/dl
MCHC 32.6 g/dl ALT 60 u/l
RDW 15% GPT 16 u/l
MPV 8.1 fl TOT BIL 2.65 mg/dl
PDW 17 % ALB 3.3 g/dl
 Exam Date 10.08.2015
Antropometry 1. Length 50 cm
2. Arm Circumference 8 cm
3. Head Circumference 52
4. Chest Circumference 28 cm
5. Weight 4400 gr
CN STATUS Eyes Open (+)
Loud Cry (+)
Active Movements (-) Ass: S4
CD STATUS HR 168 x/mnt Saturation 95%
Noisy (-)
ADP (+)
CRT <2 Ass: no abnormalities
 RESPIRATORY STATUS RR 42 x/mnt
Retractions (-)
Cianosis (-)
Air entry (+)
Ass: DS0
GI STATUS Defecation 25 ml/die
GI sounds (-)
Vomiting (-)
Itterus (-)
Ass: no abn
GENITOURINARY STATUS Urine 515 ml/die
BC Fluid -166 ml/die
Diuresis 4.8 ml/kg/h
INFECTIOUS STATUS T 36.7 C
No fever
 Assessment
1. Congenital hydrocephalus DD
Hydranencephaly
2. Respiratory distress is improving
3. Potential Infections
4. Polydactily
5. History of asphyxia
6. Neo M, normal weight, a term, AGA, caesarian
procedure
 Therapy
O2 1-2 l/mnt
Mothers milk 20-30 mlx8/die
D10%:D1/4 in normal saline + D40 in normal

saline + KCl 5 cc + Calcium gluconate 10 cc

Ampicillin 150 mg/12h
Aminosterile 50 cc/die -> 20 cc/die -> stop
 Plan
Head CT SCAN with contrast
Blood colture
 Monitoring
Blood glucose 1/die
Vital signs
Fluid balance
 Prognosis
Still doubtful
 Head CT scan results

Obstructive

Hydrocephalus with
Aqueduct Stenosis
 Hydrocephalus In Children
Lancet. 2015 Aug 6. pii: S0140-6736(15)60694-8. doi: 10.1016/S0140-
6736(15)60694-8. [Epub ahead of print]
Hydrocephalus in children .
Abstract
Hydrocephalus is a common disorder of cerebral spinal fluid (CSF) physiology
resulting in abnormal expansion of the cerebral ventricles. Infants commonly
present with progressive macrocephaly whereas children older than 2 years
generally present with signs and symptoms of intracranial hypertension. The
classic understanding of hydrocephalus as the result of obstruction to bulk flow of
CSF is evolving to models that incorporate dysfunctional cerebral pulsations, brain
compliance, and newly characterised water-transport mechanisms. Hydrocephalus
has many causes. Congenital hydrocephalus, most commonly involving
aqueduct stenosis, has been linked to genes that regulate brain growth and
development. Hydrocephalus can also be acquired, mostly from pathological
processes that affect ventricular outflow, subarachnoid space function, or cerebral
venous compliance. Treatment options include ventriculoperitoneal shunt and
endoscopic approaches, which should be individualised to the child. The long-
term outcome for children that have received treatment for hydrocephalus varies.
Advances in brain imaging, technology, and understanding of the pathophysiology
should ultimately lead to improved treatment of the disorder.
 What about treatment?
Long-term outcome and neurologic development after
endoscopic third ventriculostomy versus shunting during
infancy.
Abstract
INTRODUCTION:
Infants with obstructive hydrocephalus who were under 9 months old were
initially treated by neuroendoscopic third ventriculostomy (ETV) after
evaluation with magnetic resonance imaging (MRI). The clinical course and
long-term outcome of these infants were examined. The outcome was also
compared with that of similar infants who received ventriculoperitoneal
shunting.
CONCLUSIONS:
In infants with obstructive hydrocephalus in whom the cerebral cortex
is intact, adequate development can be achieved with ETV alone,
although catch-up tends to be slow. In infants in whom cerebral
development is inadequate or in whom the cerebrum has already been
affected by hydrocephalus, sufficient improvement of development
cannot be achieved with ETV alone, even if the intracranial pressure is
controlled. It seems that early shunting is more useful for achieving
cerebral recovery in this patient group.
 Cost-consequence analysis of antibiotic-impregnated
shunts and external ventricular drains in hydrocephalus.
Abstract
OBJECT:
Despite multiple preventive strategies for reducing infection, up to 15% of
patients with shunt catheters and 27% of patients with external ventricular
drains (EVDs) may develop an infection. There are few data on the cost-
effectiveness of measures to prevent hydrocephalus catheter infection from
the hospital perspective. The objective of this study was to perform a cost-
consequence analysis to assess the potential clinical and economic value of
antibiotic-impregnated catheter (AIC) shunts and EVDs compared with
non-AIC shunts and EVDs in the treatment of hydrocephalus from a
hospital perspective.
CONCLUSIONS:
The current value analysis demonstrates that evidence supports the use
of AICs as effective and potentially cost-saving treatment.
Thank You For Your Attention.