New data show that critical neonatal hydrocephalus, which is sometimes caused by fetal and neonatal alloimmune thrombocytopenia (FNAIT), can be effectively managed with a two-step surgical plan that improves outcomes for premature and low birth weight infants, according to a review published recently in Turkish Neurosurgery.
FNAIT can lead to severe complications such as cerebral bleeding, which may result in hydrocephalus, a buildup of fluid in the brain. In a review of 64 newborns treated over nine years, researchers found that tailoring surgery based on each baby’s condition and correctly timing them helped save lives and improve development.
“Neonatal hydrocephalus is a common complication of neurosurgery for which early diagnosis is crucial to ensure patients receive timely treatment,” the authors wrote. “By analyzing and summarizing our experience with the treatment of neonatal hydrocephalus, we found that timely and reasonable treatment commonly results in a good prognosis for patients with critical neonatal hydrocephalus.”
Most infants in this study had brain bleeding (59.1%), which can occur in FNAIT due to the immune system attacking fetal platelets. Other causes included infection (24.0%) and unknown origins (16.9%). Many babies were born too early, with 84.3% preterm, and had extremely low to low birth weights. Every infant required surgery, with 95.3% improving when doctors followed a carefully planned two-phase process.
Read more about FNAIT causes and risk factors
The first step focused on stabilizing the baby by managing infection or bleeding and supporting weight gain and growth. Once the infant was strong enough, the second step was to place a permanent brain shunt that helped drain excess fluid. This approach was tested on a baby girl born at 26 weeks with a birth weight of 1,000 grams. She underwent temporary drainage first and later received a shunt. A year after treatment, her growth and brain development showed clear improvement.
Procedures used included extra-ventricular drainage, Ommaya reservoir placement, and ventriculoperitoneal shunts. Fewer cases required endoscopic or atrial shunts. Families of infants with hydrocephalus due to FNAIT should understand that with close monitoring and timely care, recovery is very possible.
This review highlights how important it is for parents and providers to act quickly if FNAIT is suspected to improve outcomes for their infants.
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