A temporary treatment for posthemorrhagic hydrocephalus (PHH) in newborn babies may lower the chance that a baby will later need a permanent brain shunt, according to a recent study published in the Journal of Neurosurgery. A brain shunt is a small tube placed during surgery to help drain extra fluid from the brain to another part of the body.
PHH is a serious condition that can happen in babies affected by fetal and neonatal alloimmune thrombocytopenia (FNAIT). FNAIT occurs when a pregnant woman’s immune system mistakenly attacks her baby’s platelets — blood cells that help stop bleeding. FNAIT can lead to bleeding in the brain, which can cause PHH.
PHH happens when blood and swelling block the normal flow of cerebrospinal fluid, the fluid that surrounds and protects the brain. When this fluid cannot drain properly, it builds up and causes pressure inside the brain. This pressure can be harmful if it is not treated.
Doctors often use temporary treatments to relieve pressure in the brain, until a baby grows big enough to receive permanent treatment for PHH.
This study found that babies treated with neuroendoscopic lavage were least likely to need a permanent brain shunt. In neuroendoscopic lavage, a neurosurgeon places a tiny camera (called an endoscope) into the baby’s brain to see the blood clots, and gently washes them out with sterile fluid to help restore normal flow of cerebrospinal fluid).
However, the researchers said that “no clear conclusions can be drawn at the current stage about the superiority of any of the techniques” and “further research will be performed to draw clearer conclusions.”
Read more about FNAIT prognosis
To shed light on which temporary treatment for PHH works best, researchers carried out an international study called the Treatment of Posthemorrhagic Hydrocephalus in neonates (TROPHY) study .
The study included 238 newborn babies with PHH. Of these, 47 received a ventricular access device, 34 received external ventricular drainage, 75 received ventricular subgaleal shunt and 82 received neuroendoscopic lavage (NEL). Doctors followed the babies for six months after treatment.
While babies treated with neuroendoscopic lavage were least likely to need a permanent brain shunt, those treated with ventricular subgaleal shunt were most likely to need one.
The study also found that the frequency of serious complications and repeat surgeries was similar across all treatments.
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