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Temporal trends in paediatric hydrocephalus - Rising prematurity and persistent ophthalmological challenges
Alexandra U C Wrede1, Farah Mastrouk2, Nina R Björkander3
1Department of Ophthalmology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Insights
Pediatric hydrocephalus cases show increased extreme prematurity over time. Many children experience vision issues, requiring comprehensive neurological and ophthalmological care.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Public Health
Background:
- Hydrocephalus in children presents a complex challenge due to evolving etiologies and comorbidities.
- Improved healthcare has led to changes in the pediatric hydrocephalus population.
- Understanding these shifts is crucial for optimizing patient care.
Purpose of the Study:
- To analyze changes in etiology, prematurity, comorbidity, and ophthalmological outcomes in surgically treated pediatric hydrocephalus.
- To inform healthcare strategies for this vulnerable and changing patient group.
Main Methods:
- Comparison of two population-based cohorts of children treated for hydrocephalus, born two decades apart.
- Ophthalmological examinations and registration of gestational age, etiology, and comorbidities.
- Inclusion of history taking for perceptual visual dysfunction (PVD).
Main Results:
- A significant increase in extreme prematurity (gestational age ≤ 28 weeks) was observed over two decades.
- The majority of children exhibited ophthalmological abnormalities; however, motility defects and nystagmus decreased in the later cohort.
- Subnormal visual acuity was linked to extreme prematurity, and PVD was associated with learning disability.
Conclusions:
- The population of children with hydrocephalus is evolving, with a rise in extreme preterm births.
- A high prevalence of ophthalmological abnormalities persists, necessitating integrated neurological and ophthalmological management.
- Healthcare providers must consider both neurological and ophthalmological needs for comprehensive care.
Aim:
To study changes in aetiology, prematurity, comorbidity and ophthalmological outcomes in children with surgically treated hydrocephalus to provide information needed to maintain the best possible healthcare for a fragile and changing population.
Methods:
Two population-based cohorts, born two decades apart in Region Västra Götaland Sweden, surgically treated for hydrocephalus at Sahlgrenska University Hospital in Gothenburg were recruited at approximately 10 years of age. The participants were examined according to an ophthalmological protocol, including history taking regarding perceptual visual dysfunction (PVD). Gestational age, aetiology and comorbidities were registered.
Results:
The 1989-1993 group, comprised 52 children (48% girls; mean age 10, range 7.7-12.8 years), was compared with 24 children, born in 2007-2012 (29% girls; mean age 10, range 7.0-13.8 years). Extreme prematurity (gestational age ≤ 28 weeks) increased over time (p = 0.001). The vast majority of the children showed ophthalmological abnormalities, although motility defects and nystagmus decreased in the latter population. Subnormal visual acuity was associated with extreme prematurity (RR = 4.69; p = 0.030), and PVD with learning disability (RR = 2.44; p = 0.032).
Conclusion:
Paediatric hydrocephalus populations may change with improved healthcare. Since a high percentage shows ophthalmological abnormalities and more children are born extremely preterm, the entirety needs consideration both neurologically and ophthalmologically.
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