在胎27 週5 日，胎児水腫のために帝王切開で出生した。Apgar スコアは2 点（1 分）/7 点（5 分），出生時体重 は1,250g であった。新生児呼吸窮迫症候群および頻拍があり，NICU 管理となった。入院中明らかな脳室内出血の 既往なく，日齢85 に体重2,630g で退院した。退院前の頭部MRI では明らかな異常はなかった。修正3 か月時に頭 囲の拡大と頭蓋内圧亢進症状を認め，画像検査で脳室拡大と前頭葉から側頭葉の硬膜下腔の拡大を認め外水頭症と 診断した。脳室腹腔シャント術を施行した結果，速やかに症状の改善と発達の促進を認めた。
極低出生体重児では明らかな脳室内出血の合併がなくとも進行性の外水頭症を合併する可能性が示唆された。
The patient had been delivered prematurely by Cesarean section. The patient’s gestational age was 27 weeks and 5 days and weighed 1,250g. Although the infant presented with respiratory distress syndrome requiring artificial respiration, no significant IVH was observed on MRIs obtained before the patient was discharged from the NICU. The patient was discharged at 85 days of age（ corrected age of 40 weeks and 2 days）. At a corrected age of 3 months, the patient presented with a large head circumference, as well as ICH symptoms such as irritability, abnormal eye movements, and tense anterior fontanel with stagnant development. CTs and MRIs taken at that time showed enlargement of the subarachnoidal space over the frontal to temporal area with mild enlargement of the lateral ventricles. Shunt placement surgery was deemed necessary and a ventricular peritoneal shunt procedure was performed at a corrected age of 4 months. The patient’s development subsequently showed apparent improvement.
Based on the findings for this case, we suggest that, in VLBW infants, even those without definitive IVH, the risk of hydrocephalus may warrant a surgical procedure. Thus, it would be important to assess symptoms and signs possibly caused by developed intracranial pressure, such as an enlarged head circumference or tension of the anterior fontanel, as well as conducting developmental follow-up for all VLBW infants, even those without a history of IVH.
