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VP shunt

i have pt 5 months old male
he had congenital hydrocephalus , Vp shunt was inserted but after one month shunt was obstructed another VP shunt inserted and same problem occured , now pt had infection EVD was inserted and CSF taken many time for analysis with persist high protien more than 1030 and cell > 45 % pt , interventricular gentamycin injected interventricular many times now last resut almost the same , pt still on EVD , afebrile with recurrent attacks of vomiting with no fits . blood culture -ve , pt was seen may time and evaluated by pediatrcian .
please any one help me to give the pt the best management .
***@**** , saudi arabia
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623823 tn?1357420257
sA, Dr Nassim Abi Chahine, Lebanon

Dear colleague, we frequently meet metabolic disease in our practice, it is not easy to differentiate between them and a residue of a previous meningitis/ependymitis.. In this case I prefer to insert a large bore valve (adult) without any accessories (like antisyphone..) after a longer period of external ventricular derivation؛‎ t.he period should be well weighted before a new infection emerge, then an internalisation of the shunt should be termination under cover of effective antibioticotherapy.
This case is not too bad, it seems to have a solution.
For now let the baby just take the type of milk given to him before the age of 4 months until the primary cause of hydrocephalus is found.

Dear colleague Medhelp is not tailored for profound chating conversation, i will try to google out your adress, thank you for your help.
Dr Nassim
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