In order to determine the optimal valve pressure setting during the first weeks in neonates after implantation of programmable Hakim valves and to analyze the benefits and possible side effects of a new treatment protocol in this age group, we performed this prospective study. In 20 consecutive newborns less than 5 weeks of age with hydrocephalus due to various etiologies, a ventriculoperitoneal shunt with a programmable Hakim valve at an extremely low initial valve pressure setting of 30–40 mm H2O was implanted. This ‘overdrainage’ was maintained, monitored by regular clinical examination and transcranial ultrasonographic imaging, until the wound healing was uneventfully completed and the permanent valve pressure setting of 100–120 mm H2O was chosen. In this age group, which is prone to specific noninfectious shunt complications like wound breakdown, cerebrospinal fluid (CSF) fistula and subcutaneous CSF collections, none of these complications were seen, nor were there any persisting overdrainage phenomena on transcranial ultrasonography. Initial, temporary ‘overdrainage’ represents a simple, useful and risk-free therapy in neonates with programmable shunts which might lower the incidence of typical noninfectious complications in this age group.

Rohde V, Mayfrank L, Ramakers VT, Gilsbach JM: Four-year experience with the routine use of the programmable Hakim valve in the management of children with hydrocephalus. Acta Neurochir (Wien) 1998;140:1127–1134.
Di Rocco C, Marchese E, Velardi F: A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991–1992 Education Committee of the ISPN. Childs Nerv Syst 1994;10:321–327.
Kulkarni AV, Drake JM, Lamberti-Pasculli M: Cerebrospinal fluid shunt infection: A prospective study of risk factors. J Neurosurg 2001;94:195–201.
Mottolese C, Grando J, Convert J, Abdoulrahman M, Lelievre H, Vandenesch F, Bret P, Lapras C: Zero rate of shunt infection in the first postoperative year in children – dream or reality? Childs Nerv Syst 2000;16:210–212.
Drake JM, Kestle JR, Milner R, Cinalli G, Boop F, Piatt J Jr, Haines S, Schiff SJ, Cochrane DD, Steinbok P, MacNeil N: Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 1998;43:294–303.
Levy ML, Masri LS, McComb JG: Outcome for preterm infants with germinal matrix hemorrhage and progressive hydrocephalus. Neurosurgery 1997;41:1111–1117.
Serlo W, Fernell E, Heikkinen E, Anderson H, von Wendt L: Functions and complications of shunts in different etiologies of childhood hydrocephalus. Childs Nerv Syst 1990;6:92–94.
Taylor AG, Peter JC: Advantages of delayed VP shunting in post-haemorrhagic hydrocephalus seen in low-birth-weight infants. Childs Nerv Syst 2001;17:328–333.
Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M: Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 2000;92:31–38.
Benzel EC, Reeves JP, Nguyen PK, Hadden TA: The treatment of hydrocephalus in preterm infants with intraventricular haemorrhage. Acta Neurochir (Wien) 1993;122:200–203.
Davis SE, Levy ML, McComb JG, Masri-Lavine L: Does age or other factors influence the incidence of ventriculoperitoneal shunt infections? Pediatr Neurosurg 1999;30:253–257.
Reinprecht A, Dietrich W, Bertalanffy A, Czech T: The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus. Childs Nerv Syst 1997;13:588–593.
Yamashita N, Kamiya K, Yamada K: Experience with a programmable valve shunt system. J Neurosurg 1999;91:26–31.
Schuster V, Mingers AM, Seidenspinner S, Nussgens Z, Pukrop T, Kreth HW: Homozygous mutations in the plasminogen gene of two unrelated girls with ligneous conjunctivitis. Blood 1997;90:958–966.
Schuster V, Seidenspinner S, Muller C, Rempen A: Prenatal diagnosis in a family with severe type I plasminogen deficiency, ligneous conjunctivitis and congenital hydrocephalus. Prenat Diagn 1999;19:483–487.
Caldarelli M, Di Rocco C, La Marca F: Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst 1996;12:748–754.
Choux M, Genitori L, Lang D, Lena G: Shunt implantation: Reducing the incidence of shunt infection. J Neurosurg 1992;77:875–880.
Hayashi T, Hashimoto T, Fukuda S, Anegawa S, Torigoe R: Clinical analysis of shunted hydrocephalic neonates and sucklings. Observation of postshunt complication due to overdrainage from intraventricular CSF (in Japanese). No To Shinkei 1990;42:1167–1171.
Badiane SB, Sakho Y, Kabre A, Ba MC, Gueye EM, Kone S, Gueye M: Non-infectious complications of treatment of hydrocephalus by shunt (in French). Dakar Med 1992;37:15–19.
Drake JM, Kestle J: Rationale and methodology of the multicenter pediatric cerebrospinal fluid shunt design trial. Pediatric Hydrocephalus Treatment Evaluation Group. Childs Nerv Syst 1996;12:434–447.
Pudenz RH, Foltz EL: Hydrocephalus: Overdrainage by ventricular shunts. A review and recommendations. Surg Neurol 1991;35:200–212.
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