Are ventriculo-subgaleal shunts successful in preventing permanent shunt placement in neonates with post-hemorrhagic hydrocephalus? An experience from a Children’s Hospital NICU

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ESPR83
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Abstract: :

Background

Post hemorrhagic hydrocephalus (PHH) remains one of the most serious complications in preterm neonates with intra-ventricular hemorrhage (IVH). There are several surgical temporizing methods currently being used as an early management option, however, data comparing their effectiveness and complication rate has been mixed. The data is lacking to support any individual temporizing procedure's superiority in reducing the incidence of permanent shunt placement. One of the commonly used methods is ventriculo-subgaleal shunt (VSGS), with a reported shunt conversion rate of 50-85%. The benefits, potential complications and shunt conversion rate with VSGS vary significantly, and largely depend on the individual centers.


Objective

To evaluate the effectiveness of ventriculo-subgaleal shunt in preventing permanent shunt placement in neonates with post-hemorrhagic hydrocephalus in a level IV NICU.


Methods

This is a retrospective cross-sectional data performed at a level IV Children's hospital NICU from January 2014 to May 2020. The infants with PHH who received ventriculo-subgaleal shunt placement as initial neurosurgical temporizing measure were included in the study. Infants with congenital or post-infectious hydrocephalus, and infants who received other temporizing measure were excluded from the study.  Baseline demographics, clinical characteristics, and procedure outcome data was collected from a NICU database and EMR. A subsequent requirement of permanent shunt placement was reviewed, and correlation with associated risk factors were examined. Chi square test and students t- test were used for statistical analysis. The study was approved by institutional review board. 


Results:

A total of 41 infants received VSGS as neurosurgical temporizing intervention for infants with PHH at our institution during the study period. Thirty-five (85.4%) infants went on to require permanent shunt placement while 6 (14.6%) were successfully managed with VSGS at least till 13 months after the initial procedure (Table 1). The median number of days between initial VSGS and permanent shunt placement was 57 days, with a range of 21 to 230 days. Majority of the infants required permanent shunt placement from 30-60 days after initial surgery (43%) (Figure 1). By Kaplan-Meier analysis, the 180-day rates of shunt conversion from VSGS to a permanent shunt was 81.5%. There was no statistically significant difference recorded for the gestational age, birth weight or highest IVH grade among the infants who did not require shunt conversion after VSGS placement. Their gestational age (GA) ranged from 24-38 weeks with 3 out of 6 patients (50%) born at >28 weeks of gestation (Table 1). 


Conclusion:

Ventriculo-subgaleal shunt placement could successfully prevent permanent shunt placement in 1 in 7 patients with PHH at our center for at least more than a year. Further larger studies are needed to evaluate the efficacy of VSGS to avoid shunt conversion in neonates with PHH.

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Nemours/Alfred I DuPont Hospital for Children
Nemours/Alfred I duPont Hospital for Children
Nemours/Alfred I duPont Hospital for Children
Nemours/Alfred I duPont Hospital for Children

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