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Predictors of ventriculoperitoneal shunt among babies with intraventricular hemorrhage
A R Hansen1, E N Allred, A Leviton
1Joint Program in Neonatology, Children's Hospital, Boston, MA 02115, USA.
Insights
Certain prenatal and postnatal care practices may reduce the need for ventriculoperitoneal shunt in infants with intraventricular hemorrhage. This suggests improved obstetric and neonatal care could lower shunt requirements in premature infants.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Neurocritical Care
Background:
- Intraventricular hemorrhage (IVH) is a significant concern in neonates, particularly premature infants.
- Ventriculoperitoneal (VP) shunts are sometimes required to manage hydrocephalus secondary to IVH.
- Identifying factors influencing the need for VP shunts is crucial for optimizing infant care.
Purpose of the Study:
- To determine medical care practices associated with the requirement for VP shunt in infants diagnosed with IVH.
- To explore maternal, perinatal, and neonatal risk factors predicting the need for VP shunt after IVH.
Main Methods:
- Retrospective review of medical records for 82 infants with ultrasonographically confirmed IVH.
- Comparison of 10 infants requiring VP shunt with 72 control infants who had IVH but did not require a shunt or succumb before discharge.
- Analysis of maternal, perinatal, and neonatal variables as potential predictors.
Main Results:
- Maternal preeclampsia, prenatal steroid administration, and cesarean delivery were linked to a decreased risk of requiring a VP shunt.
- Infants needing a VP shunt were more likely to have received dopamine, larger volumes of intravenous fluids (albumin, red blood cells), and exhibited higher rates of acidosis, patent ductus arteriosus, and systolic hypertension.
- Established risk factors for IVH also appear to correlate with the progression to needing a VP shunt.
Conclusions:
- Prenatal and postnatal care practices may influence the likelihood of needing a VP shunt in infants with IVH.
- Optimizing obstetric and neonatal care holds the potential to reduce the incidence of VP shunt placement in very low birthweight infants with IVH.
Abstract:
We aimed to identify medical care practices that influence the need for ventriculoperitoneal shunt among infants who develop intraventricular hemorrhage. We reviewed the medical records of 82 babies with ultrasonographically documented intraventricular hemorrhage. We compared the 10 babies who required a ventriculoperitoneal shunt to the 72 controls who had intraventricular hemorrhage, but did not require a ventriculoperitoneal shunt or die, prior to discharge. We considered maternal, perinatal, and neonatal risk factors as potential predictive variables. Maternal preeclampsia, prenatal steroids, and cesarean delivery were associated with a reduced risk of shunt. Patients who did require a shunt were more likely than their nonshunted peers to be treated with dopamine, to receive greater volumes of total intravenous fluid, largely as albumin and red blood cells, and to have a higher incidence of acidosis, patent ductus arteriosus and systolic hypertension. Previously identified antecedents and correlates of intraventricular hemorrhage appear also to be the antecedents and correlates of progression to ventriculoperitoneal shunt among infants with intraventricular hemorrhage. These findings are consistent with the possibility that prenatal and postnatal care practices influence the risk for ventriculoperitoneal shunt among babies with intraventricular hemorrhage. This offers the promise that changes in obstetric and neonatal care will reduce the need for ventriculoperitoneal shunt in very low birthweight infants.