Abstract
Objective:
Controlled removal of cerebrospinal fluid (CSF) by serial tapping of ventricular reservoir, such as the McComb reservoir, is an effective way to decompress the ventricular system in preterm infants with rapidly progressing post-hemorrhagic ventricular dilatation (PHVD) while awaiting optimal conditions for permanent CSF drainage through a ventriculo-peritoneal shunt. However, the data regarding the risk of infection from repeated invasive tapping of a ventricular reservoir over a prolonged period are scarce. The aim of this study is to determine the incidence of ventricular reservoir infection from repeated tapping and to evaluate how often reservoir infection accompanies blood culture-proven sepsis in preterm infants with PHVD.
Study Design:
We reviewed the medical records of all infants with PHVD receiving serial reservoir tap at the University of Michigan from January 2000 through June 2007. Serial reservoir taps were carried out by the neonatology team using aseptic technique. Surveillance CSF cultures were sent on a weekly basis as per unit practice or when clinical sepsis was suspected. Reservoir-tapping-related infection was present if a reservoir became infected during serial tapping 7 days or more after surgical placement of the reservoir.
Result:
During the study period, ventricular reservoirs were placed in 35 infants for management of hydrocephalus. Six infants (17%) received ventricular reservoirs secondary to post-meningitic hydrocephalus or congenital brain malformations and were excluded. In the remaining 29 infants (birth weight: 1070±639 g (range 525 to 3204); gestational age: 26.9±4.1 weeks (range 23 to 40)) with PHVD, serial tapping of the ventricular reservoir was performed on 681 occasions (average number of taps per infant: 24 (range 2 to 82)). There were no cases of CSF culture-proven reservoir infection related to repeated taps. Thirteen of the 29 (45%) infants with PHVD developed blood culture-proven late onset sepsis with the following organisms: coagulase-negative Staphylococcus (9), Candida albicans (2), Escherichia coli (1), and Staphylococcus aureus (1), but all of the accompanying CSF cultures from the reservoir were negative.
Conclusion:
Ventricular reservoir infection from serial taps neither occurred in this consecutive series of preterm infants with PHVD, nor did ventricular reservoir infection accompany blood culture-proven sepsis. Concern of reservoir infection from repeated tapping should not be a limiting factor against placement of reservoirs.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Murphy BP, Inder TE, Rooks V, Taylor GA, Anderson NJ, Mogridge N et al. Posthaemorrhagic ventricular dilatation in the premature infant: natural history and predictors of outcome. Arch Dis Child Fetal Neonatal Ed 2002; 87: F37–F41.
Kazan S, Gura A, Ucar T, Korkmaz E, Ongun H, Akyuz M . Hydrocephalus after intraventricular hemorrhage in preterm and low-birth-weight infants: analysis of associated risk factors for ventriculoperitoneal shunting. Surg Neurol 2005; 64 (S2): S77–S81.
Cherian S, Whitelaw A, Thoresen M, Love S . The pathogenesis of neonatal post-hemorrhagic hydrocephalus. Brain Pathol 2004; 14 (3): 305–311.
De Vries LS, Liem KD, van Dijk K, Smit BJ, Sie L, Rademaker KJ et al. Early versus late treatment of posthaemorrhagic ventricular dilatation: results of a retrospective study from 5 neonatal intensive care units in the Netherlands. Acta Paediatr 2002; 91: 212–217.
McComb JG, Ramos AD, Platzker AC, Henderson D, Segall HD . Management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant with a subcutaneous ventricular catheter reservoir. Neurosurgery 1983; 13 (3): 295–300.
Gaskill SJ, Marlin AE, Rivera S . The subcutaneous ventricular reservoir: an effective treatment for posthemorrhagic hydrocephalus. Childs Nerv Syst 1988; 4: 291–295.
Leonhardt A, Steiner HH, Linderkamp O . Management of posthaemorrhagic hydrocephalus with a subcutaneous ventricular catheter reservoir in premature infants. Arch Dis Child 1989; 64 (1): 24–28.
Richard E, Cinalli G, Assis D, Pierre-Kahn A, Lacaze-Masmonteil T . Treatment of post-haemorrhage ventricular dilatation with an Ommaya's reservoir: management and outcome of 64 infants. Childs Nerv Syst 2001; 17: 334–340.
Hudgins RJ, Boydston WR, Gilreath CL . Treatment of posthemorrhagic hydrocephalus in the preterm infant with a ventricular access device. Pediatr Neurosurg 1998; 29: 309–313.
Whitelaw A, Thoresen M, Pople I . Posthaemorrhagic ventricular dilatation. Arch Dis Child Fetal Neonatal Ed 2002; 86: F72–F74.
Willis BK, Kumar CR, Wylen EL, Nanda A . Ventriculosubgaleal shunts for posthemorrhagic hydrocephalus in premature infants. Pediatr Neurosurg 2005; 41 (4): 178–185.
Ventriculomegaly Trial Group. Randomised trial of early tapping in neonatal posthaemorrhagic ventricular dilatation: results at 30 months. Arch Dis Child Fetal Neonatal Ed 1994; 70 (2): F129–F136.
Brouwer AJ, Groenendaal F, Van den Hoogen A, Verboon-Maciolek M, Hanlo P, Rademaker KJ et al. Incidence of infections of ventricular reservoirs in the treatment of post-haemorrhagic ventricular dilatation: a retrospective study (1992–2003). Arch Dis Child Fetal Neonatal Ed 2007; 92 (1): F41–F43.
Bruinsma N, Stobberingh EE, Herpers MJ, Vles JS, Weber BJ, Gavilanes DA . Subcutaneous ventricular catheter reservoir and ventriculoperitoneal drain-related infections in preterm infants and young children. Clin Microbiol Infect 2000; 6 (4): 202–206.
Benzel EC, Reeves JP, Nguyen PhK, Hadden ThA . The treatment of hydrocephalus in preterm infants with intraventricular hemorrhage. Acta Neurochir 1993; 122: 200–203.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kormanik, K., Praca, J., Garton, H. et al. Repeated tapping of ventricular reservoir in preterm infants with post-hemorrhagic ventricular dilatation does not increase the risk of reservoir infection. J Perinatol 30, 218–221 (2010). https://doi.org/10.1038/jp.2009.154
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2009.154
Keywords
This article is cited by
-
Ventriculosubgaleal shunt: an institutional experience
Child's Nervous System (2023)
-
Standardizing treatment of preterm infants with post-hemorrhagic hydrocephalus at a single institution with a multidisciplinary team
Child's Nervous System (2020)
-
TROPHY registry study design: a prospective, international multicenter study for the surgical treatment of posthemorrhagic hydrocephalus in neonates
Child's Nervous System (2019)
-
Pharmacological Preventions of Brain Injury Following Experimental Germinal Matrix Hemorrhage: an Up-to-Date Review
Translational Stroke Research (2016)
-
Ventricular access device infection rate: a retrospective study and review of the literature
Child's Nervous System (2014)