Dear Editor:

The recent article on the retrospective evaluation of antibiotic-impregnated external ventricular drainage (EVD) for post-hemorrhagic hydrocephalus in 13 premature, very low birth weight infants is an interesting read [1]. The authors used Codman® Bactiseal™ EVD catheter which slowly diffuses a combination of antibiotics: 0.15% Clindamycin and 0.054% Rifampicin into the inner lumen and external catheter wall for up to 28 days [2]. This is one of the initial works on the subject in premature babies with promising results considering the complications and problems associated with other surgical interventions at such young age and low weights. We would like to make a few points through this letter.

Authors did regular EVD revision in two infants if weight was less than 2 kg with EVD malfunction or when long-term EVD was expected. However, the initial EVD was used in 5 babies for more than 28 days (35–57 days) and second EVD was used in two babies beyond 28 days (48 and 51 days) but none of these babies developed ventriculostomy associated infection. This would likely suggest good EVD care practice in their hospital since the usual antibiotic dispersion duration is 28 days [2]. Furthermore, the importance of maintenance of a sterile closed-drainage system, aseptic precautions during EVD handling, and hand hygiene cannot be understated. Also, longitudinal assessment of other developmental measures, assessment of long-term neurodevelopmental outcomes using diagnostic developmental assessment scales, and cost-consequence analysis of antibiotic-impregnated EVDs in large multicentric cohorts of premature babies with post-hemorrhagic hydrocephalus is needed [3,4,5]. This can be practice-changing, especially for resource-limited settings.