Beating the Odds: Prematurity and Posthemorrhagic Hydrocephalus

Abstract

Lucy was a miracle child. She overcame extreme odds and significant medical complications to become a spunky, chatty, child beauty pageant contestant. When she was referred for an evaluation at age 5 years by a neurosurgeon, she was doing well academically in a regular-education kindergarten classroom. However, both her parents and teachers acknowledged that she talked “too much” and had “selective hearing” problems. Directions at home and at school often needed to be repeated several times before Lucy would comply. Lucy appeared easily distracted, especially by her own thoughts or stories, which she enjoyed creating and telling to others. Lucy was also a social butterfly who was indiscriminant in her socialization and would approach anyone, even strangers, to begin a conversation. She was described as a very physically active but clumsy young girl who didn't enjoy down time. Overall, though, Lucy was simply a happy and delightful little girl who was immediately liked by all who met her.

Lucy was born 13 weeks early, after 27 weeks of gestation. Weighing less than 2 pounds at birth, her whole body practically fit in the palm of her father's hand. Unfortunately, Lucy's father wasn't able to hold her as much as he would have liked during the first 3 months of her life. Lucy stayed in the neonatal intensive care unit for 11 weeks. She experienced medical complications typically associated with premature birth, including immature lungs, necessitating use of a ventilator for several weeks; patent ductus arteriosus, a heart malformation requiring ligation surgery; retinopathy of prematurity, requiring bilateral eye surgery; and jaundice, requiring light treatment. Most significantly, on day 3 of life, Lucy sustained a Grade III intraventricular hemorrhage affecting both cerebral hemispheres (Table 1.1). She subsequently developed hydrocephalus and underwent 11 spinal taps to control her intracranial pressure, but placement of a ventriculoperitoneal shunt was not deemed necessary at the time (Table 1.2).