Delayed germinal matrix hemorrhage induced by ventriculoperitoneal shunt insertion for congenital hydrocephalus

Abstract

Germinal matrix hemorrhages (GMHs) are typically seen in preterm neonates during the first 4 days of life. The authors encountered 2 children with late-onset GMH subsequent to ventriculoperitoneal (VP) shunt insertion for congenital hydrocephalus. Both children were delivered at full term with normal body weight, although they were compromised with the preceding hypoxic events prior to shunt insertion. The first case involved a female infant with severe craniofacial deformities. Because of aspiration pneumonia related to the comorbid upper airway stenosis, endotracheal intubation with intermittent mechanical ventilation was necessary. The associated congenital hydrocephalus was treated with VP shunt insertion when she was 35 days of age, and GMH was confirmed 1 week after shunt placement. During a period of conservative observation, the hemorrhage resolved without any neurological deterioration. The second case involved a male infant with a large intraparenchymal cyst on the left parietal portion. He was intubated for pneumonia at 1 month of age. He had associated congenital hydrocephalus that was progressive, and he was treated with VP shunting at 69 days of age, after his pneumonia had resolved. Postoperative GMH was confirmed, although hydrocephalus was well controlled by VP shunt insertion. Observed conservatively, he fared well and the GMH resolved. These 2 cases had unique features in common; both had congenital anomalies in the CNS and respiratory problems before shunting. The hypoxic insults on the residual germinal matrix layer and sudden decrease in CSF pressure may relate to the occurrence of these late-onset GMHs.