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Outcomes and prognostic factors of infantile acquired hydrocephalus: a single-center experience
Faliang Zhou1, Zhao Yang2, Zezhong Tang1
1Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China.
Insights
Late surgical intervention and severe ventricular dilation predict adverse outcomes in infants with acquired hydrocephalus. Identifying causes is crucial for prognosis and developing better treatments for this condition.
Area of Science:
- Pediatric Neurology
- Neonatal Care
- Neurodevelopmental Disorders
Background:
- Infantile acquired hydrocephalus presents significant challenges in diagnosis and management.
- Understanding the etiologies and prognostic factors is critical for improving infant outcomes.
Purpose of the Study:
- To assess the causes and adverse outcomes of infantile acquired hydrocephalus.
- To identify predictors of prognosis in affected infants.
Main Methods:
- A cohort of 129 infants with acquired hydrocephalus was studied from 2008 to 2021.
- Adverse outcomes included mortality and neurodevelopmental impairment (defined by Bayley Scales III, cerebral palsy, sensory impairments, epilepsy).
- Prognostic factors were analyzed using Chi-squared tests and receiver operating characteristic curves.
Main Results:
- 48.7% of infants experienced adverse outcomes.
- Late surgical intervention (median 13 days) and severe ventricular dilation were associated with adverse outcomes.
- The combination of surgical timing and cranial ultrasonography (cUS) indices offered superior prediction compared to individual factors.
Conclusions:
- Late surgical treatment and severe ventricular dilation are key predictors of adverse outcomes in infantile acquired hydrocephalus.
- Etiology identification is vital for predicting prognosis.
- Further research is needed to develop interventions that improve outcomes for infants with acquired hydrocephalus.
Aim:
To assess the etiologies and adverse outcomes of infantile acquired hydrocephalus and predict prognosis.
Methods:
A total of 129 infants diagnosed with acquired hydrocephalus were recruited from 2008 to 2021. Adverse outcomes included death and significant neurodevelopmental impairment which was defined as Bayley Scales of Infant and Toddler Development III score < 70, cerebral palsy, visual or hearing impairment, and epilepsy. Chi-squared was used to evaluate the prognostic factors of adverse outcomes. A receiver operating characteristic curve was calculated to determine the cutoff value.
Results:
Of 113 patients with outcome data, 55 patients (48.7%) had adverse outcomes. Late surgical intervention time (13 days) and severe ventricular dilation were associated with adverse outcomes. The combination of surgical intervention time and cranial ultrasonography (cUS) indices was a better predictive marker compared with any of them (surgical intervention time, P = 0.05; cUS indices, P = 0.002). Post-hemorrhage (54/113, 48%), post-meningitis (28/113, 25%), and hydrocephalus arising from both hemorrhage and meningitis (17/113, 15%) accounted for a large proportion of the etiologies in our study. Hydrocephalus occurs secondary to post-hemorrhage and had a favorable outcome compared with other etiologies in both preterm and term groups. A significant difference in adverse outcomes between the inherited error of metabolism as a cause and other etiologies (P = 0.02).
Conclusion:
Late surgical treatment times and severe ventricular dilation can predict adverse outcomes in infants with acquired hydrocephalus. It is crucial to identify the causes of acquired hydrocephalus to predict the adverse outcomes. Research into measures of improving adverse outcomes following infantile acquired hydrocephalus is urgently necessary.
