Clinical Experience of Infantile Posthemorrhagic Hydrocephalus Treated with Ventriculo-Peritoneal Shunt

Survival status and predictors of mortality among children who underwent ventriculoperitoneal shunt surgery at public hospitals in Addis Ababa, Ethiopia

Background: Despite the increase in ventriculoperitoneal shunt surgeries performed for children with hydrocephalus, the potential complications and survival of patients after the procedure remains the major challenge for both clinical and public health aspects. This study intends to assess the survival status and scrutinize the predictive factors of mortality among children after a ventriculoperitoneal shunt.Methods: A retrospective cohort study was employed by reviewing charts of 337 systematically selected children who have undergone a ventriculoperitoneal shunt from 2016 to 2018 in Addis Ababa. The extraction tool was used for data collection, Epi-data version 4.4.2 for data entry, and Stata version-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, and life table were used to describe the data. Cox proportional hazard regression model was used for analysis. Any variable at p < 0.25 in the bi-variable analysis was fitted to multivariate analysis, and significance was declared at p ≤ 0.05. Then, AHR with 95% CI was used to report the association and test the statistical significance. Finally, texts and tables were used to present the results.Results and Conclusion: The incidence rate of mortality was 58.4 per 1000 child-months of observation with a median survival time of 12 months (95%CI: 9.04-14.96). Communicative hydrocephalus (AHR: 1.99, 95% CI: 1.18-3.36), post-traumatic brain injury (AHR: 7.43, 95% CI: 3.21-16.88), emergency surgery (AHR: 1.86, 95% CI: 1.17-3.13) as well as revised shunt procedure (AHR: 8.01, 95% CI: 6.12-13.43) were independent predictors of death. Besides, sunset eye (ARH: 2.01; 95% CI: 1.17-3.47), rapidly increased head size (ARH: 2.05, 95% CI: 1.14-3.37), prolonged antibiotics treatment (AHR: 2.46, 95% CI: 1.82-7.37), and gram-negative infections (AHR: 1.95, 95% CI: 1.60-12.64) were also significantly associated. Hence, health professionals ought to give special attention to patients with identified predictors.

Posthemorrhagic Hydrocephalus With Decompensation Of Cerebrospinal Fluid Dynamics In Newborns: New In Treatment Tactics

Background ― Posthemorrhagic hydrocephalus in newborns with occlusion of cerebrospinal fluid leads to decompensation of cerebrospinal fluid dynamics. There is no single method that meets all the criteria for the effectiveness and safety of treatment. The study goal was to investigate the use of coronary translambdoid subarachnoid ventriculostomy (CTSV) and ventricular subarachnoid stenting (VSS) in the treatment of neonatal hydrocephalus. Material and Methods ― The analysis of the posthemorrhagic hydrocephalus treatment in 327 newborns for the period of 2000-2018 in Crimea. Two groups have been identified. In the Group 1, 184 children underwent standard treatment according to the ‘LVV protocol’ with lumbar and ventricular punctures with 20-22G needles, while with progression of hydrocephalus, with ventriculosubgaleal drainage and ventriculoperitoneal shunt. In 143 children with occlusion and ventricular block, the treatment complex included CTSV – RF Patent No. 2715535, and ventricular drainage by the ventricular subarachnoid stenting (VSS) – RF Patent No. 2721455. Results ― An increase in the treatment radicality under CTSV is achieved through the use of the cerebral needles of a larger diameter (14G) and puncture access zones, elimination of occlusion, while under VSS, restoration of intracranial circulation and absorption of cerebrospinal fluid is ensured by prolonged sanitation with a saline solution of cerebrospinal fluid spaces. A positive outcome with compensation for hydrocephalus was achieved in 75.4% of cases versus 28.2% under the conventional protocol (p<0.001). In other cases, the imbalance of production and absorption of cerebrospinal fluid remained, which required the integration of the VSS with the peritoneal segment of the shunt, without further replacement and reinstallation of the system. Conclusion ― Our results allow us to consider the effectiveness of CTSV and VSS inclusion in the contemporary algorithm for the treatment of decompensated posthemorrhagic hydrocephalus in newborns.