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Updated: May 28, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Risk factors for cerebrospinal fluid shunt infection in pediatrics: A meta-analysis
Roidah Taqiyya Zahra Wathoni1, Wihasto Suryaningtyas1, Budi Utomo2
1Department of Neurosurgery, Universitas Airlangga - Faculty of Medicine, Dr. Soetomo Academic General Hospital, Surabaya, East Java, Indonesia.
Insights
Infants under 6 months, Caucasian, and African-American children face higher risks of cerebrospinal fluid (CSF) shunt infection. This meta-analysis identified key pediatric risk factors for shunt infection, informing prevention strategies.
Area of Science:
- Pediatric Neurosurgery
- Infectious Disease Epidemiology
- Medical Statistics
Background:
- Cerebrospinal fluid (CSF) shunts are vital for hydrocephalus treatment.
- Shunt infection is a significant complication, posing medical and social challenges.
- Identifying pediatric risk factors for shunt infection is crucial for improving patient outcomes.
Purpose of the Study:
- To conduct a meta-analysis investigating risk factors for shunt infection in pediatric patients.
- To synthesize existing evidence on factors associated with CSF shunt infection in children.
Main Methods:
- Systematic literature search of PubMed, Scopus, and Cochrane Library.
- Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Inclusion of five relevant publications for meta-analysis.
Main Results:
- Infants under 6 months showed a significantly higher risk (RR 33.06).
- Caucasian race (RR 15.24) and African-American race (RR 2.37) were associated with increased infection risk.
- Factors like prematurity-related intraventricular hemorrhage and gastrostomy presence were not significant in this analysis.
Conclusions:
- Younger age (<6 months), Caucasian, and African-American race are significant risk factors for pediatric CSF shunt infection.
- Previously suggested risk factors require further investigation in larger cohorts.
- Future research should focus on extensive populations and comprehensive risk factor analysis for shunt infection.
Background:
Placement of cerebrospinal fluid (CSF) shunt for diversion remains a primary treatment for patients with hydrocephalus despite its surgical complications, including shunt infection, that remain high and become a medical and social problem. The meta-analysis was conducted to investigate risk factors of shunt infection in pediatrics.
Methods:
Literature was searched on PubMed, Scopus, and the Cochrane Library. The methodology used for this investigation was preferred reporting items for systematic reviews and meta-analysis.
Results:
This meta-analysis included five publications. The only significant results were found in ages <6 months with relative risk (RR) of 33.06 (95% confidence interval [CI] 9.27-117,99; P < 0.01), Caucasian race with RR of 15.24 (95% CI 6.77-34.34), and African-American race with RR of 2.37 (95% CI 2.07-2.70). The other results provided were not significant, such as intraventricular hemorrhage (IVH) of prematurity as the etiology of hydrocephalus with RR of 4.71 (95% CI 1.07-20.82), presence of gastrostomy during shunt insertion with RR of 3.80 (95% CI 0.91-15.88), and comorbidity of respiratory diseases with RR of 0.22 (95% CI 0.11-0.43).
Conclusion:
Younger age during the shunt placement procedure, Caucasian race, and African-American race have a significantly higher risk of CSF shunt infection. The previously reported higher risk of shunt infection in cohort studies, such as IVH of prematurity and the presence of gastrostomy, were not significant in this study. Primary studies regarding shunt infection are advocated to be performed in a more extensive population with further risk factors included in the analysis.
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