Safety and feasibility of a novel oesophageal stimulation protocol in modulating aerodigestive mechanisms and outcomes in infants at-risk for gastrostomy: a pilot study.

Posthemorrhagic hydrocephalus (PHH) is a serious complication of intraventricular hemorrhage in preterm infants and may result in progressive brain injury and long-term neurological sequelae. Although several temporizing surgical interventions are available, no clinical consensus has been established regarding their optimal selection and application. Preterm infants are particularly susceptible to intraventricular hemorrhage (IVH) because of the immaturity of the cerebral vasculature, and its incidence increases with decreasing gestational age. Following IVH, posthemorrhagic hydrocephalus (PHH) may develop through several mechanisms, including mechanical obstruction by blood clots, the release of inflammatory mediators, and transforming growth factor--mediated fibrosis (). Studies have shown that PHH develops in approximately 9% of preterm infants with IVH, with reported incidence rates of 1%, 4%, 25%, and 28% among infants with grade I, II, III, and IV IVH, respectively (). If left untreated, PHH can cause progressive ventricular dilation, leading to white matter and deep gray matter injury, reduced cerebellar volume, and subsequent neurological sequelae (). Current management strategies for PHH include temporizing CSF diversion, permanent shunting, and medical therapy. Because early placement of a permanent ventriculoperitoneal shunt (VPS) is associated with numerous complications, increasing attention has been directed toward temporizing interventions. However, selecting an appropriate temporizing procedure requires careful consideration of both its efficacy and the risk of complications. This review summarizes current temporizing interventions, including serial lumbar puncture (LP), external ventricular drainage (EVD), ventriculosubgaleal shunt (VSGS), ventricular access device (VAD), neuroendoscopic lavage (NEL), and drainage, irrigation, and fibrinolytic therapy (DRIFT), as well as their associated complications. The review aims to provide a reference for the clinical management of PHH.