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Epidemiology of infantile hydrocephalus in Sweden. II. Origin in infants born at term
Insights
Infantile hydrocephalus (IH) with prenatal origins, often caused by toxoplasmosis or post-hemorrhagic conditions, leads to significantly higher risks of death and neurological impairment in affected children.
Area of Science:
- Pediatrics
- Neurology
- Epidemiology
Background:
- Infantile hydrocephalus (IH) is a significant pediatric neurological condition.
- Understanding the diverse etiologies of IH is crucial for predicting outcomes.
- Previous studies have highlighted various causes, but population-based data on onset and sequelae are essential.
Purpose of the Study:
- To investigate the etiological factors of infantile hydrocephalus (IH) in a defined population.
- To analyze the relationship between the onset of IH (prenatal, perinatal, postnatal) and patient outcomes.
- To identify specific etiological agents, such as toxoplasmosis and post-hemorrhagic conditions, associated with IH.
Main Methods:
- A population-based study of 141 children diagnosed with IH, born between 1967 and 1982 in southwestern Sweden.
- Classification of IH etiology into prenatal, perinatal, and postnatal categories.
- Long-term follow-up to assess mortality and neurological impairments in relation to etiological group.
Main Results:
- A prenatal etiology was identified in 57% of cases, perinatal in 19%, and postnatal in 6%; 13% were untraceable.
- Toxoplasmosis was the dominant intrauterine infection, and post-hemorrhagic IH was the predominant perinatal condition.
- Children with prenatal IH onset faced a significantly higher risk: 21% mortality before age 2 and 68% of survivors with major neurological dysfunction, compared to 3% mortality and 30% sequelae in other groups.
Conclusions:
- The onset of infantile hydrocephalus (IH) is strongly associated with patient outcomes.
- Prenatal onset IH presents a considerably worse prognosis, characterized by high rates of early death and severe neurological deficits.
- Targeted interventions and further research into prenatal causes are critical for improving outcomes in infantile hydrocephalus.
Abstract:
The aetiology of infantile hydrocephalus (IH) was studied in a population-based series of 141 children with IH, born at term in southwestern Sweden 1967-82. A prenatal aetiology was present in 81 children (57%), a pre- and perinatal in 6 (4%), a perinatal in 27 (19%), and a postnatal in 8 (6%); the origin in 19 children (13%) remained untraceable. A variety of aetiologies were revealed or indicated among prenatal conditions. The dominant intrauterine infection was toxoplasmosis. The predominant perinatal condition was posthaemorrhagic IH. The broad outline of outcome differed between pathogenetic groups. Children with a clear prenatal onset of IH were found to be at high risk for early death or multiple neurological impairments. Thirteen of 63 (21%) within this group had died before 2 years of age and 34 of the 50 (68%) survivors showed major neurological dysfunction. This contrasted to the incidences of 3% deaths and 30% sequelae in children with IH of other onset.