Ultrasound-guided neuronavigation-the safest approach for Rickham capsule insertion in preterm infants

Aims: Preterm birth and low birth weight are major causes of morbidity and mortality in neonates. Although the last two decades have seen advances in specialized care of preterm infants with significantly improved survival despite very low birth weights, intra-ventricular hemorrhage (IVH) causing posthemorrhagic hydrocephalus (PHH) still is one of the most severe and difficult to treat complications of prematurity. In preterm infants, the management of IVH by implantation of a Rickham Capsule is often associated with complications and remains a challenge both for neonatologists and pediatric neurosurgeons, compounded by the lack of low-risk, validated therapy techniques.

The aim of this study was to evaluate the feasibility and safety of ultrasound guided placement of a Rickham Capsule as a novel technique for treatment of PHH in a cohort of preterm, low-birth-weight babies.

Methods: Eight preterm infants with PHH received Rickham Capsule placement between 2008 and 2012. In four preterm infants, conventional surgical techniques were used, in the other four prematures the catheter was placed using an 8 Mega Hertz micro convex transducer from LOGIQ 9, GE Healthcare; the anterior fontanel was used as an acoustic window.

Results: Overall gestational age was 24 to 31 weeks and mean age at operation was 20.1 (7 to 36) days; mean birth weight was 972.5 ± 370 g and mean weight at first surgical intervention 1023.75 ± 400.4 g. Bilateral IVH II-III° occurred in 6 patients; two patients had parenchymal involvement. In one of four patients below 1,000 g the catheter was placed incorrectly by using the conventional approach, whereas none of the ultrasound guided cases needed correction.

Conclusion: Ultrasound-guided neuronavigation is an appropriate technique for the treatment of hydrocephalus in preterm infants due to increased accuracy in placement of a central catheter connected to a Rickham Capsule.