Follow-up for Hydrocephalus After Intraventricular Hemorrhage in Infants

Frequency of Office Visits

• Time of initial postoperative visit: The initial visit should be 1 week after surgery for wound review and/or sutures removal.
• Time of first follow-up visit and who should be seen: The patient should return 3–6 weeks after surgery for a neurosurgical review.
• Frequency of subsequent visits and who should be seen: A pediatric review should occur every month. A neurosurgical review should occur every 3 months up to the first year and then every 6 months. A neurologist and/or neurodevelopmental specialist should be seen at discharge and then every 3–6 months.

Frequency of Imaging

• Perioperative ultrasounds: Cranial ultrasounds can be performed at the bedside very easily with no specific time frame. Usually one scan immediately after surgery and one prior to discharge are enough.
• Time of baseline scan: Some surgeons obtain plain x-rays (shunt series) immediately after surgery as a baseline. Others prefer a CT scan for baseline in the first postoperative week (size of ventricles, position of ventricular catheter, parenchymal injuries).
• Frequency of subsequent scans: At future follow-up visits and if the anterior fontanelle is still open, cranial ultrasounds can assess the size of the ventricles. There is no need for serial CT scans. At the first year an MRI scan can be performed for the assessment of ventricular size, mantle thickness, and white matter abnormalities.

Other Investigations Required

A baseline neurodevelopmental evaluation is required prior to discharge. At that point a multidisciplinary team (neonatologist, neurodevelopmental specialist, and neurosurgeon) can provide a first estimation for the possible future outcome on the basis of clinical and radiological findings.