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1/10. The subcutaneous ventricular reservoir: an effective treatment for posthemorrhagic hydrocephalus.

    Use of the subcutaneous ventricular reservoir in the treatment of posthemorrhagic hydrocephalus was studied in a series of 38 patients. All of the patients were considered to be medically labile. Additionally, all had failed conservative modes of therapy consisting of lumbar punctures with or without furosemide or acetazolamide. Management of the hydrocephalus consisted of reservoir placement. Subsequently, taps were performed at various intervals and amounts, depending upon the degree of ventricular dilatation as determined by sonography and signs of increased intracranial pressure. The majority of reservoirs were left in place for 1-2 months. There were no reservoir infections. Once the patients were medically stable, the reservoir was removed and a shunt placed. Eight patients died before shunt placement and 2 patients died after shunting, reflecting a 29% mortality. In no case was a death related to the shunt, but rather reflected the medical lability of the patient population. Four patients (15% of surviving patients) did not require shunting. The total shunt infection rate was 6.9% (among survivors with a shunt in place, 7.7%). These results support the use of the reservoir as an easy and effective means of protecting the cortical mantle while decreasing morbidity related to future shunt placement.
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2/10. The incidence of meningitis in neonates with necrotizing enterocolitis.

    Although meningitis is common among patients with neonatal sepsis, review of the literature on necrotizing enterocolitis (NEC) reveals a paucity of information on the association of NEC and meningitis. We report four patients who had meningitis during the course of illness among 238 patients with documented NEC. We recommend that all patients with suspected NEC have a lumbar puncture as part of the diagnostic work-up, as meningitis may require different and prolonged therapy, and will necessitate more specific follow-up for neurodevelopmental problems.
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3/10. Iatrogenic arteriovenous fistula after multiple arterial punctures.

    Multiple arterial punctures in the neonate can result in iatrogenic arteriovenous fistula formation. In one case, a 3-month-old infant who had been born prematurely was noted to have physical findings consistent with arteriovenous malformation following approximately 90 arterial blood gas determinations over a 13-week period. The area was explored and the lesion was treated surgically with good results.
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4/10. Transient hydrocephalus in premature infants: Treatment by lumbar punctures.

    Three premature infants with post-haemorrhagic hydrocephalus were treated by removing large volumes of cerebrospinal fluid with repeated lumbar punctures. After this treatment, a computerised tomographic brain scan showed that ventricle size had decreased, and subsequent head growth was normal in all three patients. The results suggest that acquired hydrocephalus in premature infants may be transient and that ventricular shunts may not be necessary in all cases.
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5/10. osteomyelitis of the great toe secondary to phlebotomy.

    A premature infant developed Staphylococcus osteomyelitis secondary to multiple punctures of the great toe for drawing blood. The infection responded well to antibiotic therapy.
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6/10. epidural abscess and vertebral osteomyelitis following serial lumbar punctures.

    Lumbar epidural abscess and vertebral osteomyelitis were diagnosed in a 3-month-old infant, born prematurely, who had had repeated lumbar punctures for the treatment of posthemorrhagic hydrocephalus. staphylococcus aureus was the causative organism. Successful treatment was achieved with 6 weeks of intravenous antibiotics without surgical drainage. Infectious complications of lumbar punctures are rare, but may occur when multiple punctures are attempted in small premature infants whose subarachnoid space contains large amounts of blood. infection can be introduced directly by a contaminated spinal needle, or trauma to the tissues with bleeding can create a favorable site for bacterial adherence and multiplication. Posthemorrhagic ventricular dilation often resolves spontaneously and serial lumbar punctures should be used to treat this condition only when CSF flow is easy to establish and maintain.
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ranking = 8
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7/10. Surgical correction of choanal atresia in the neonate.

    The purpose of this paper is to present a technique of endonasal puncture and stenting for bilateral choanal atresia in the neonate that is easily performed and may be definitive. The procedure described is original only in its details, its broad principles are well known. A method of placing the nasal stent is reported that is particularly applicable in the premature, even as small as five pounds. No antibiotics or steroids are given in the postoperative period. Three months is the recommended duration of stenting. Four patients were operated on using this technique, between July 1978 and August 1979; 3 were complete successes; 1 was a bilateral failure, but was re-operated on and was then a unilateral success. Shortest follow-up was 16 months. We feel endonasal puncture and stenting of bilateral choanal atresia in the neonate can be definitive, and is the first procedure of choice.
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8/10. Neurosurgical management of intraventricular haemorrhage in preterm infants.

    A review of intraventricular haemorrhage (IVH) diagnosed in 103 preterm infants from 1983 to 1993 describes the presenting features and management of this condition. In this 10-year period, 37 infants with IVH developed post-haemorrhagic hydrocephalus (PHH), defined as ventriculomegaly, raised intracranial pressure and increasing head circumference. PHH was treated by external ventricular drainage and/or ventriculo-peritoneal shunting; but other drainage procedures like lumbar punctures and subcutaneous ventricular reservoir were used occasionally. Relative indications, merits and demerits of these various surgical options is discussed and results summarized. High incidence of neuro-developmental handicap and its correlation with the grade of haemorrhage and PHH is emphasized. External ventricular drainage (EVD) was found to be an effective and safe therapy for rapidly progressive PHH and increased intracranial pressure. Ultimate outcome depended mainly on the grade of haemorrhage, severity of PHH and promptness of its neurosurgical management.
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9/10. Alterations in spinal fluid drainage in infants with hydrocephalus.

    We describe two cases of hydrocephalus in which spinal sonography revealed underlying causes responsible for the failure of therapeutic lumbar punctures.
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10/10. hydrocephalus secondary to intracranial hemorrhage in premature infants.

    Premature (low birth weight) infants are particularly susceptible to intracranial hemorrhage. This frequently arises from the subependymal area and may dissect into the brain or into the ventricles. If the infant survives, hydrocephalus is a frequent sequela. Because of major improvements in the care of premature infants in recent years and the proliferation of intensive care nurseries, increasing numbers of low birth weight infants are surviving and developing hydrocephalus. Seven cases are described of infants who developed hydrocephalus following intracranial bleeding. Initially, ventricular and lumbar punctures were done to attempt to control head growth but this was unsuccessful. Two were treated with temporary external ventriculostomy which did not permanently control the hydrocephalus. Definitive treatment included ventriculo-atrial shunts using an expandable 'telescopic' cardiac catheter in two and ventriculoperitoneal shunts in five. The pathogenesis and management of the condition are discussed.
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