Shunt timing in low-weight infants in the treatment of hydrocephalus

Peter A. Chiarelli Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California; and

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Nicholas Chapman Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California; and

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Benjamin E. Flyer Wake Forest University School of Medicine, Winston-Salem, North Carolina

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Jason K. Chu Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California; and

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Mark D. Krieger Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California; and

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OBJECTIVE

The optimal timing of ventricular shunt placement in low-weight and preterm infants remains an unresolved topic in modern pediatric neurosurgery. Shunt placement for hydrocephalus is performed over a wide range of infant weights, and the standard weight threshold for shunt placement can vary substantially across institutions. The aim of this study was to investigate shunt outcome in infants of low body weight.

METHODS

An IRB-approved retrospective analysis of 76 infants (29 females, 47 males) who received primary shunt placement between 2003 and 2018 was performed. Uniform criteria were used over the entire dataset to determine the safety for ventriculoperitoneal (VP) shunt placement: 1) weight near or above 1500 g, 2) feeding tolerance, and 3) lack of necrotizing enterocolitis or active systemic infection. Infants were classified into a low-weight (LW) (< 2000 g) or standard weight (SW) (2000–3000 g) group based on their body weight at the time of initial shunt placement. Shunt survival was compared between the groups. The threshold weight separating the LW and SW groups and outcomes was additionally varied and systematically reanalyzed.

RESULTS

Shunts were placed in 24 LW infants and 52 SW infants over the inclusion period. Etiologies for hydrocephalus were similar across groups: predominantly intraventricular hemorrhage (54%) (p = 0.13) and open neural tube defect (29%) (p = 0.61). Both LW and SW groups had 58% 1-year shunt survival rates. Overall, 46% of shunts failed in the LW group compared with 54% in the SW group over a median follow-up of 47 months (range 0–170 months). A log-rank test comparing shunt survival rates did not show significance (p = 0.43). Groups were repartitioned using a range of threshold weights (1600–2400 g) to divide LW from SW infants. The lack of association between VP shunt placement in LW infants and time frame of revision was consistently observed over the full range of varied threshold weights.

CONCLUSIONS

There was no significant difference in overall time to shunt revision between infants weighing < 2000 g and infants weighing 2000–3000 g. No correlation between weight and shunt survival was detected. Combined with other clinical features pertinent to the management of hydrocephalus in the neonatal population, this investigation provides insight toward clinical decision-making regarding infants of low birth weight and suggests that further multi-institutional study on this topic is warranted.

ABBREVIATIONS

LW = low-weight; NTD = neural tube defect; PIVH = periventricular-intraventricular hemorrhage; RBC = red blood cell; RDS = respiratory distress syndrome; RR = rate ratio; SW = standard weight; VP = ventriculoperitoneal; VR = ventricular reservoir; VSGS = ventriculosubgaleal shunt.

Supplementary Materials

    • Supplementary Tables 1 and 2 (PDF 203 KB)
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