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Preterm-related posthemorrhagic hydrocephalus: Review of our institutional series with a long-term follow-up
Pablo Miranda1, Juan Antonio Simal1, Estela Plaza1
1Servicio de Neurocirugía, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Insights
This study reviewed preterm-related posthemorrhagic hydrocephalus shunt outcomes, finding that protocol changes improved results safely. Most infants achieved normal development or mild impairment despite common shunt complications.
Area of Science:
- Pediatric Neurosurgery
- Neonatal Neurology
- Hydrocephalus Research
Background:
- Preterm-related posthemorrhagic hydrocephalus (PHH) is a leading cause of infant neurological deficits.
- Ventriculoperitoneal shunts are common but associated with significant complications.
- Evolving diagnostic and treatment protocols necessitate outcome evaluation.
Purpose of the Study:
- To analyze clinical characteristics and outcomes of preterm infants with PHH requiring shunts (1982-2020).
- To assess the safety and efficacy of updated treatment protocols implemented in 2015.
Main Methods:
- Retrospective review of 133 preterm infants who received shunts.
- Long-term follow-up evaluating shunt complications and neurological development.
- Analysis of protocol changes' impact on clinical results.
Main Results:
- Shunt infection occurred in 15 patients; proximal obstruction affected 46% by 5 years.
- 61 patients developed small or collapsed ventricles.
- Two-thirds of patients had normal or mild neurological impairment.
- Protocol changes showed improvements in outcomes.
Conclusions:
- Clinical outcomes align with existing literature.
- Updated protocols are safe and enhance patient results.
- Programmable shunts are safe for preterm infants but do not prevent ventricular collapse.
Introduction:
Preterm-related posthemorrhagic hydrocephalus is a major cause of neurological impairment and a common indication for a ventriculoperitoneal shunt in infants that are prone to diverse complications. Protocols of diagnosis and treatment are in continuous evolution and require evaluation of their results.
Objective:
To review the clinical characteristics and results of a series of preterm-related posthemorrhagic hydrocephalus needing a definitive shunt from 1982 to 2020 in our institution. As a secondary objective we evaluated the safety of the changes in our protocol of treatment from 2015.
Methods:
Retrospective review, clinical investigation.
Results:
133 patients were implanted a shunt in the study period. Shunt infection was diagnosed in 15 patients. Proximal shunt obstruction as the first complication was diagnosed in 30% of cases at one year, 37% at two years and 46% at five years. 61 patients developed very small or collapsed ventricles at last follow-up. Two thirds of our patients achieved normal neurological development or mild impairment. Changes in protocol did not significantly modify clinical results although improvement in most outcomes was observed. Mean follow-up was over nine years.
Conclusions:
Clinical outcomes are comparable to previous reported data. Changes in protocol proved to be safe and improved our results. Programmable shunts can be used safely in preterm patients although they may not prevent tendency towards ventricular collapse, which is very common after long follow-up.
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