antiedeme measures in raised ICP in intracranial bleed

[selvanr4]

Recently we had a newborn with intrauterine pneumonia having resistant seizures, apnoea and corneal edema following Intracranial bleed. We ventilated the baby, kept up fluid restricion,given anticonvulsants. Nothing worked until we started on anti edema treatment with mannitol and dexamethasone for 48 hrs. Baby impoved well, seizures controlled , recovered.

Do you advocate mannitol in raised ICP ? Do you use dexamethasone? We have not used it till now.

Give me your feedback and brickbats if any.

dr.selvan

Erode

Edited February 9, 2010 by selvanr4

[Stefan Johansson]

Mannitol, I have never come across this drug in neonatal care. Increased ICP in neonates, difficult topic since the cranial bones are not fixed and that head circumference can grow with increasing pressure.

I have just made a quick search on medline and found this promising reference:

Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 11. Use of hyperosmolar therapy in the management of severe pediatric traumatic brain injury.

http://www.ncbi.nlm.nih.gov/pubmed/12847347

Unfortunaltey, no abstract or free full-text showed up beside the ref, but if you have access to that journal, it might be interesting reading.