Neonatal hydrocephalus: Hemodynamic response to fontanelle compression - Correlation with intracranial pressure and need for shunt placement

PURPOSE: To determine whether the hemodynamic response to fontanelle compression during Doppler sonography can be used to indirectly assess intracranial pressure and help determine the need for shunt placement in hydrocephalic infants. MATERIALS AND METHODS: Sixty Doppler sonographic examinations were performed to obtain resistive indexes before and during fontanelle compression in 14 hydrocephalic infants. Twenty-five intracranial pressure measurements were obtained in 12 infants during cerebrospinal fluid removal and correlated with the change in resistive index during compression of the anterior fontanelle. RESULTS: Baseline resistive index without fontanelle compression was not correlated with intracranial pressure (r = .1, P = .63). A statistically significant correlation was found between the change in resistive index during compression and elevated intracranial pressure (r = .8, P < .0001). Maximum change in resistive index was significantly higher (P < .001) in infants who subsequently required surgical intervention (mean [+/- standard deviation], 74% +/- 9; range, 47%-132%) than in infants who did not require ventricular drainage (mean, 19% +/- 6; range, 3%-29%, P < .0003). CONCLUSION: Hemodynamic response to fontanelle compression can be used as a noninvasive predictor of progressive or persistently elevated intracranial pressure in newborns with hydrocephalus and may be helpful in predicting need for shunt placement.