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Updated: May 11, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Shunt infection in the first year of life
Meysam A Kebriaei1, Mohammadali M Shoja, Steven M Salinas
1Pediatric Neurosurgery Associates at Children's Healthcare of Atlanta, Atlanta, Georgia 30342, USA.
Insights
Infants undergoing shunt placement face increased infection risk from additional surgeries soon after placement or prior cardiac surgery. These findings are crucial for managing pediatric hydrocephalus and preventing complications.
Area of Science:
- Pediatric Neurosurgery
- Infectious Disease Epidemiology
- Neonatal Physiology
Background:
- Infants younger than 1 year have unique physiology and comorbidities, potentially altering shunt infection risk factors.
- Congenital malformations in infants often necessitate multiple surgical interventions, increasing infection susceptibility.
- Existing literature suggests distinct risk factors for shunt infection in this young population compared to older children.
Purpose of the Study:
- To investigate the specific risk factors for cerebrospinal fluid (CSF) shunt infection in infants during their first year of life.
- To determine the association between other invasive procedures and the timing of shunt insertion with shunt infection rates.
- To identify independent risk factors for shunt infection in neonates and young infants.
Main Methods:
- Prospective data collection over 3 years (2008-2010) on 270 infants receiving initial CSF shunt placement.
- Detailed recording of clinical characteristics, hospital course, and shunt infections.
- Focused analysis on the types and timing of other invasive procedures relative to shunt infection.
Main Results:
- Infants with gestational age < 30 weeks, preshunt cardiac surgery, and post-shunt procedures within 30 days showed higher infection risk.
- Multivariate analysis confirmed preshunt cardiac surgery and early post-shunt procedures as significant independent risk factors.
- Shunt infection occurred in 22 of 270 patients, with organisms identified in 20 cases.
Conclusions:
- Surgical procedures performed within 30 days following shunt insertion increase infection risk in infants.
- Preshunt cardiac surgery is a significant risk factor for shunt infection in infants receiving CSF shunts.
- These findings highlight critical periods and procedures associated with shunt infection in this vulnerable pediatric population.
Object:
Children younger than 1 year of age are unique in their physiology and comorbidities. Reports in the literature suggest that the risk factors for shunt infection may be different in this population compared with older children. Importantly, these infants often have other congenital malformations requiring various surgical interventions, which impose an additional risk of infection.
Methods:
In the 3-year period between 2008 and 2010, 270 patients underwent initial CSF shunt placement during the 1st year of life. Clinical characteristics, hospital course, and shunt infections were prospectively recorded in the practice and hospital electronic medical record. Special attention was given to types and timing of other invasive procedures and their relationship with shunt infection.
Results:
The average gestational age was 33.6 weeks, and the average birth weight was 2333 g. The average weight at the time of shunt insertion was 4281 g. Prior to shunt insertion, 120 patients underwent 148 surgical procedures, including ventricular access device insertion (n = 63), myelomeningocele closure (n = 37), and cardiac procedures (n = 11), among others. In the 12-month period after shunt insertion, 121 of the 270 patients underwent 135 surgical procedures, which included 79 CSF shunt revisions. Shunt infection occurred in 22 patients, and organisms were identified in 20 cases. Univariate analysis showed that of the very prematurely born infants (gestational age < 30 weeks), those who underwent preshunt cardiac surgery and any surgical procedures within 30 days after the shunt insertion were at a greater risk of shunt infection. In multivariate analysis, preshunt cardiac surgery and surgical procedures within 30 days postshunt placement were significant risk factors independent of gestational age, birth weight, and history of shunt revisions.
Conclusions:
The results of this study suggest that surgical procedures within 30 days after shunt insertion and preshunt cardiac surgery are associated with a greater risk of shunt infection in children in whom these devices were inserted during the 1st year of life.
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