Effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus

LIU Yun-Feng; HUANG Chun-Ling; TONG Xiao-Mei; ZHANG Yang; ZENG Lin; YUAN Jin-Fang

doi:10.7499/j.issn.1008-8830.2108119

PDF(783 KB)

Chinese Journal of Contemporary Pediatrics ›› 2021, Vol. 23 ›› Issue (12) : 1214-1220. DOI: 10.7499/j.issn.1008-8830.2108119

CLINICAL RESEARCH

Effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus

LIU Yun-Feng, HUANG Chun-Ling, TONG Xiao-Mei, ZHANG Yang, ZENG Lin, YUAN Jin-Fang

Author information +

History +

Abstract

Objective To study the effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus. Methods A retrospective analysis was performed on the medical data of 49 preterm infants with obstructive hydrocephalus. According to the treatment regimen, they were divided into two groups: surgical treatment (n=12) and conservative treatment (n=37). The drainage methods, drainage complications, and eventual shunt outcome were analyzed in the surgical treatment group. The two groups were compared in terms of the etiology of hydrocephalus and prognosis. Results Among the 49 preterm infants with obstructive hydrocephalus, severe intracranial hemorrhage (37 cases; 76%) and central nervous system infection (10 cases, 20%) were the main causes of hydrocephalus. There was no significant difference in the composition of etiology between the two groups (P>0.05). In the surgical treatment group, 4 infants were treated with ventriculosubgaleal shunt and 8 were treated with Ommaya reservoir. One infant had secondary infection and 8 infants eventually underwent ventriculoperitoneal shunt. The surgical treatment group had a significantly higher survival rate than the conservative treatment group (P<0.05). As for the 37 preterm infants with severe intracranial hemorrhage, the surgical treatment group had a significantly higher proportion of infants with normal neurodevelopment than the conservative treatment group (P<0.05). As for the 10 preterm infants with central nervous system infection, neurodevelopmental abnormalities were observed in each of the two groups. Conclusions Surgical treatment can improve the survival rate of preterm infants with obstructive hydrocephalus and the prognosis of preterm infants with severe intracranial hemorrhage.

Key words

Hydrocephalus / Surgery / Treatment / Prognosis / Preterm infant

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

LIU Yun-Feng, HUANG Chun-Ling, TONG Xiao-Mei, ZHANG Yang, ZENG Lin, YUAN Jin-Fang. Effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus[J]. Chinese Journal of Contemporary Pediatrics. 2021, 23(12): 1214-1220 https://doi.org/10.7499/j.issn.1008-8830.2108119

References

1 Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts[J]. J Neurosurg Pediatr, 2012, 9(3): 242-258. PMID: 22380952. PMCID: PMC3842211. DOI: 10.3171/2011.12.PEDS11136.
2 郝江丽, 姜毅, 朱家叶, 等. 新生儿脑积水病因特点及治疗结局的研究[J]. 中华新生儿科杂志, 2017, 32(1): 21-26. DOI: 10.3969/j.issn.2096-2932.2017.01.006.
3 Garcia-Navarro V, Perez-Vega C, Robles-Lomelín P, et al. Early intervention and neurodevelopmental outcome of infants with posthemorrhagic hydrocephalus: a case series and literature review[J]. Clin Neurol Neurosurg, 2021, 201: 106432. PMID: 33383466. DOI: 10.1016/j.clineuro.2020.106432.
4 Levene MI. Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound[J]. Arch Dis Child, 1981, 56(12): 900-904. PMID: 7332336. PMCID: PMC1627506. DOI: 10.1136/adc.56.12.900.
5 Sondhi V, Gupta G, Gupta PK, et al. Establishment of nomograms and reference ranges for intra-cranial ventricular dimensions and ventriculo-hemispheric ratio in newborns by ultrasonography[J]. Acta Paediatr, 2008, 97(6): 738-744. PMID: 18397357. DOI: 10.1111/j.1651-2227.2008.00765.x.
6 Gilard V, Chadie A, Ferracci FX, et al. Post hemorrhagic hydrocephalus and neurodevelopmental outcomes in a context of neonatal intraventricular hemorrhage: an institutional experience in 122 preterm children[J]. BMC Pediatr, 2018, 18(1): 288. PMID: 30170570. PMCID: PMC6119335. DOI: 10.1186/s12887-018-1249-x.
7 Sorinola A, Buki A, Sandor J, et al. Risk factors of external ventricular drain infection: proposing a model for future studies[J]. Front Neurol, 2019, 10: 226. PMID: 30930840. PMCID: PMC6428739. DOI: 10.3389/fneur.2019.00226.
8 MacLeod R, Paulson JN, Okalany N, et al. Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: the IVHU study[J]. BMC Pediatr, 2021, 21(1): 12. PMID: 33407279. PMCID: PMC7786968. DOI: 10.1186/s12887-020-02464-4.
9 Peros T, van Schuppen J, Bohte A, et al. Neonatal bacterial meningitis versus ventriculitis: a cohort-based overview of clinical characteristics, microbiology and imaging[J]. Eur J Pediatr, 2020, 179(12): 1969-1977. PMID: 32621136. PMCID: PMC7666663. DOI: 10.1007/s00431-020-03723-3.
10 Brouwer MJ, de Vries LS, Pistorius L, et al. Ultrasound measurements of the lateral ventricles in neonates: why, how and when? A systematic review[J]. Acta Paediatr, 2010, 99(9): 1298-1306. PMID: 20394588. DOI: 10.1111/j.1651-2227.2010.01830.x.
11 Valdez Sandoval P, Hernández Rosales P, Qui?ones Hernández DG, et al. Intraventricular hemorrhage and posthemorrhagic hydrocephalus in preterm infants: diagnosis, classification, and treatment options[J]. Childs Nerv Syst, 2019, 35(6): 917-927. PMID: 30953157. DOI: 10.1007/s00381-019-04127-x.
12 van Lindert EJ, Liem KD, Geerlings M, et al. Bedside placement of ventricular access devices under local anaesthesia in neonates with posthaemorrhagic hydrocephalus: preliminary experience[J]. Childs Nerv Syst, 2019, 35(12): 2307-2312. PMID: 31506779. DOI: 10.1007/s00381-019-04361-3.
13 Hepburn-Smith M, Dynkevich I, Spektor M, et al. Establishment of an external ventricular drain best practice guideline: the quest for a comprehensive, universal standard for external ventricular drain care[J]. J Neurosci Nurs, 2016, 48(1): 54-65. PMID: 26720321. DOI: 10.1097/JNN.0000000000000174.
14 Zhang Y, Zhao R, Shi W, et al. Predictor of a permanent shunt after treatment of external ventricular draining in pediatric postinfective hydrocephalus—a retrospective cohort study[J]. Childs Nerv Syst, 2021, 37(6): 1877-1882. PMID: 33483758. DOI: 10.1007/s00381-021-05054-6.
15 张扬, 侯新琳, 王红梅, 等. 脑室帽状腱膜下引流术治疗早产儿脑室内出血后脑积水临床分析[J]. 中国新生儿科杂志, 2015, 30(2): 94-97. DOI: 10.3969/j.issn.1673-6710.2015.02.005.
16 Bock HC, Feldmann J, Ludwig HC. Early surgical management and long-term surgical outcome for intraventricular hemorrhage-related posthemorrhagic hydrocephalus in shunt-treated premature infants[J]. J Neurosurg Pediatr, 2018, 22(1): 61-67. PMID: 29726792. DOI: 10.3171/2018.1.PEDS17537.
17 Wellons JC, Shannon CN, Holubkov R, et al. Shunting outcomes in posthemorrhagic hydrocephalus: results of a hydrocephalus clinical research network prospective cohort study[J]. J Neurosurg Pediatr, 2017, 20(1): 19-29. PMID: 28452657. DOI: 10.3171/2017.1.PEDS16496.
18 George T, Moorthy RK, Rajshekhar V. Long tunnel external ventricular drain: an adjunct in the management of patients with infection associated hydrocephalus[J]. Br J Neurosurg, 2019, 33(6): 659-663. PMID: 31549855. DOI: 10.1080/02688697.2019.1667483.
19 Fountain DM, Chari A, Allen D, et al. Comparison of the use of ventricular access devices and ventriculosubgaleal shunts in posthaemorrhagic hydrocephalus: systematic review and meta-analysis[J]. Childs Nerv Syst, 2016, 32(2): 259-267. PMID: 26560885. PMCID: PMC4749661. DOI: 10.1007/s00381-015-2951-8.
20 Riva-Cambrin J, Shannon CN, Holubkov R, et al. Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage[J]. J Neurosurg Pediatr, 2012, 9(5): 473-481. PMID: 22546024. PMCID: PMC3361965. DOI: 10.3171/2012.1.PEDS11292.
21 Radic JAE, Vincer M, McNeely PD. Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010[J]. J Neurosurg Pediatr, 2015, 15(6): 580-588. PMID: 26030329. DOI: 10.3171/2014.11.PEDS14364.
22 Yang XT, Feng DF, Zhao L, et al. Application of the Ommaya reservoir in managing ventricular hemorrhage[J]. World Neurosurg, 2016, 89: 93-100. PMID: 26724628. DOI: 10.1016/j.wneu.2015.12.040.
23 Chen B, Zhai Q, Ooi K, et al. Risk factors for hydrocephalus in neonatal purulent meningitis: a single-center retrospective analysis[J]. J Child Neurol, 2021, 36(6): 491-497. PMID: 33393419. DOI: 10.1177/0883073820978032.