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Neuropediatrics 2022; 53(01): 001-006
DOI: 10.1055/s-0041-1732311
Original Article

Potential Risk Factors for Ventriculoperitoneal Shunt Implantation in Paediatric Patients with Posthemorrhagic Hydrocephalus of Prematurity Treated with Subcutaneous Reservoir: An Institutional Experience

Adam K. Bębenek 
1   Department of Children's Neurosurgery, Jagiellonian University Medical College, Cracow, Poland
,
Stanisław Kwiatkowski   *
1   Department of Children's Neurosurgery, Jagiellonian University Medical College, Cracow, Poland
,
Olga Milczarek   *
1   Department of Children's Neurosurgery, Jagiellonian University Medical College, Cracow, Poland
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Abstract

Background Posthemorrhagic hydrocephalus of prematurity (PHHP) is a result of intraventricular hemorrhage (IVH). IVH occurs in 6 to 23% of the preterms in countries with advanced medical health care. Most of these patients will eventually require the use of ventriculoperitoneal shunt (VPS). The purpose of this study is to assess the risk factors of VPS implantation in patients with PHHP who have been treated with ventricular catheter with subcutaneous reservoir (VCSR).

Methods The retrospective study was conducted evaluating 35 premature patients who suffered from severe IVH. Their mean gestational age was 28 weeks. The assessment included antenatal factors such as gestational age, birth weight, and intrauterine and perinatal infection. Postparturient period factors such as the IVH grade, time between diagnosis, and VCSR implantation and body weight on VCSR implantation were also considered in the study. Postprocedural complications, such as bacterial cerebrospinal fluid (CSF) infection, sepsis, and skin lesions, were evaluated. Data were calculated with R program, version 4.04.

Results From among 35 evaluated patients, 23 (65.71%) required a VPS. Median of birth weight was 1,190 g. Infections were observed in 11 (31.43%) cases. Mean time between IVH diagnosis and VCSR implantation was 2.6 weeks. Postprocedural complications occurred in 19 (54.29%) patients. None of the evaluated factors has proven its statistical significance (p > 0.05) for being a potential risk factor for VPS implantation.

Conclusion External factors seem to not affect the necessity of VPS implantation in patients after the severe IVH. Ostensibly, there seems to be no difference between the grades III and the IV of Papile's IVH scale regarding VPS implantation necessity.

Keywords

IVH - posthemorrhagic - hydrocephalus - prematurity - PHHP

* Co–senior authors.




Publication History

Received: 23 November 2020

Accepted: 29 May 2021

Article published online:
12 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Robinson S, Conteh FS, Oppong AY. et al. Extended combined neonatal treatment with erythropoietin plus melatonin prevents posthemorrhagic hydrocephalus of prematurity in rats. Front Cell Neurosci 2018; 12: 322
    CrossrefPubMedGoogle Scholar
  • 2 Del Bigio MR. Cell proliferation in human ganglionic eminence and suppression after prematurity-associated haemorrhage. Brain 2011; 134 (pt 5): 1344-1361
    CrossrefPubMedGoogle Scholar
  • 3 Leijser LM, de Vries LS. Preterm brain injury: Germinal matrix-intraventricular hemorrhage and post-hemorrhagic ventricular dilatation. Handb Clin Neurol 2019; 162: 173-199
    CrossrefPubMedGoogle Scholar
  • 4 Klebe D, McBride D, Krafft PR, Flores JJ, Tang J, Zhang JH. Posthemorrhagic hydrocephalus development after germinal matrix hemorrhage: established mechanisms and proposed pathways. J Neurosci Res 2020; 98 (01) 105-120
    CrossrefPubMedGoogle Scholar
  • 5 Holt PJ. Posthemorrhagic hydrocephalus. J Child Neurol 1989; 4 (suppl): S23-S31
    CrossrefPubMedGoogle Scholar
  • 6 Korobkin R. The relationship between head circumference and the development of communicating hydrocephalus in infants following intraventricular hemmorrhage. Pediatrics 1975; 56 (01) 74-77
    CrossrefPubMedGoogle Scholar
  • 7 du Plessis AJ, Volpe JJ. Perinatal brain injury in the preterm and term newborn. Curr Opin Neurol 2002; 15 (02) 151-157
    CrossrefPubMedGoogle Scholar
  • 8 Kuo MF. Surgical management of intraventricular hemorrhage and posthemorrhagic hydrocephalus in premature infants. Biomed J 2020; 43 (03) 268-276
    CrossrefPubMedGoogle Scholar
  • 9 Yu B, Li S, Lin Z, Zhang N. Treatment of posthemorrhagic hydrocephalus in premature infants with subcutaneous reservoir drainage. Pediatr Neurosurg 2009; 45 (02) 119-125
    CrossrefPubMedGoogle Scholar
  • 10 Whitelaw A, Creighton L, Gaffney P. Fibrinolysis in cerebrospinal fluid after intraventricular haemorrhage. Arch Dis Child 1991; 66 (7 spec no): 808-809
    CrossrefPubMedGoogle Scholar
  • 11 Cinalli G. Alternatives to shunting. Childs Nerv Syst 1999; 15 (11,12): 718-731
    CrossrefPubMedGoogle Scholar
  • 12 Albright AL, Pollack IA, Adelson PD. Principle and Practice of Pediatric Neurosurgery. 3rd ed.. New York, NY: Georg Thieme Verlag; 2015
    Google Scholar
  • 13 Rekate HL. A contemporary definition and classification of hydrocephalus. Semin Pediatr Neurol 2009; 16 (01) 9-15
    CrossrefPubMedGoogle Scholar
  • 14 Orešković D, Klarica M. Development of hydrocephalus and classical hypothesis of cerebrospinal fluid hydrodynamics: facts and illusions. Prog Neurobiol 2011; 94 (03) 238-258
    CrossrefPubMedGoogle Scholar
  • 15 Dykes FD, Dunbar B, Lazarra A, Ahmann PA. Posthemorrhagic hydrocephalus in high-risk preterm infants: natural history, management, and long-term outcome. J Pediatr 1989; 114 (4 pt 1): 611-618
    CrossrefPubMedGoogle Scholar
  • 16 Wright LC, McAllister II JP, Katz SD. et al. Cytological and cytoarchitectural changes in the feline cerebral cortex during experimental infantile hydrocephalus. Pediatr Neurosurg 1990; –1991 16 (03) 139-155
    CrossrefPubMedGoogle Scholar
  • 17 Kazan S, Güra A, Uçar T, Korkmaz E, Ongun H, Akyuz M. Hydrocephalus after intraventricular hemorrhage in preterm and low-birth weight infants: analysis of associated risk factors for ventriculoperitoneal shunting. Surg Neurol 2005; 64 (Suppl. 02) S77-S81 , discussion S81
    CrossrefPubMedGoogle Scholar
  • 18 Volpe JJ, Zipurksy A. Neurobiology of periventricular leukomalacia in the premature infant. Pediatr Res 2001; 50 (05) 553-562
    CrossrefPubMedGoogle Scholar
  • 19 de Vries LS, Liem KD, van Dijk K. et al; Dutch Working Group of Neonatal Neurology. Early versus late treatment of posthaemorrhagic ventricular dilatation: results of a retrospective study from five neonatal intensive care units in The Netherlands. Acta Paediatr 2002; 91 (02) 212-217
    CrossrefPubMedGoogle Scholar
  • 20 Chen Q, Feng Z, Tan Q. et al. Post-hemorrhagic hydrocephalus: Recent advances and new therapeutic insights. J Neurol Sci 2017; 375: 220-230
    CrossrefPubMedGoogle Scholar
  • 21 Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr 2012; 9 (03) 242-258
    CrossrefPubMedGoogle Scholar
  • 22 Wellons III JC, Shannon CN, Holubkov R. et al; Hydrocephalus Clinical Research Network. Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study. J Neurosurg Pediatr 2017; 20 (01) 19-29
    CrossrefPubMedGoogle Scholar
  • 23 Guzzetta F, Shackelford GD, Volpe S, Perlman JM, Volpe JJ. Periventricular intraparenchymal echodensities in the premature newborn: critical determinant of neurologic outcome. Pediatrics 1986; 78 (06) 995-1006
    CrossrefPubMedGoogle Scholar
  • 24 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
    CrossrefPubMedGoogle Scholar
  • 25 de Vries LS, Groenendaal F, Liem KD. et al; ELVIS study group. Treatment thresholds for intervention in posthaemorrhagic ventricular dilation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2019; 104 (01) F70-F75
    CrossrefPubMedGoogle Scholar
  • 26 Schulz M, Bührer C, Pohl-Schickinger A, Haberl H, Thomale UW. Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates. J Neurosurg Pediatr 2014; 13 (06) 626-635
    CrossrefPubMedGoogle Scholar
  • 27 Whitelaw A, Evans D, Carter M. et al. Randomized clinical trial of prevention of hydrocephalus after intraventricular hemorrhage in preterm infants: brain-washing versus tapping fluid. Pediatrics 2007; 119 (05) e1071-e1078
    CrossrefPubMedGoogle Scholar
  • 28 Whitelaw A, Pople I, Cherian S, Evans D, Thoresen M. Phase 1 trial of prevention of hydrocephalus after intraventricular hemorrhage in newborn infants by drainage, irrigation, and fibrinolytic therapy. Pediatrics 2003; 111 (4 pt 1): 759-765
    CrossrefPubMedGoogle Scholar
  • 29 Whitelaw A, Jary S, Kmita G. et al. Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years. Pediatrics 2010; 125 (04) e852-e858
    CrossrefPubMedGoogle Scholar
  • 30 Bruinsma N, Stobberingh EE, Herpers MJHM, Vles JSH, Weber BJ, Gavilanes DAWD. Subcutaneous ventricular catheter reservoir and ventriculoperitoneal drain-related infections in preterm infants and young children. Clin Microbiol Infect 2000; 6 (04) 202-206
    CrossrefPubMedGoogle Scholar
  • 31 Gerber NU, Müller A, Bellut D, Bozinov O, Berger C, Grotzer MA. Ventricular catheter systems with subcutaneous reservoirs (Ommaya reservoirs) in pediatric patients with brain tumors: infections and other complications. Neuropediatrics 2015; 46 (06) 401-409
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Prusseit J, Simon M, von der Brelie C. et al. Epidemiology, prevention and management of ventriculoperitoneal shunt infections in children. Pediatr Neurosurg 2009; 45 (05) 325-336
    CrossrefPubMedGoogle Scholar