Necrotizing enterocolitis (NEC) and posthemorrhagic hydrocephalus are both conditions that can affect preterm infants. The peritoneum is the preferred terminus for shunt placement, but another terminus is sometimes used due to subjective concerns about infection and complications related to NEC. The aim of this study was to examine the rates of ventriculoatrial (VA) and ventriculoperitoneal (VP) shunt infection and failure in pediatric patients with a history of NEC.
开云体育世界杯赔率
一个单中心回顾性研究医疗再保险cords from 2009 to 2021 was performed to identify pediatric patients with NEC who underwent shunt placement before 2 years of age. Patients were excluded if shunt placement preceded NEC diagnosis. Patient demographic characteristics, timing of shunt placement, type of shunt, shunt infections or revisions, and timing and management of NEC were extracted. The Student t-test and Fisher exact test were used to calculate significance. Kaplan-Meier curves were calculated.
RESULTS
Twenty-two patients met the inclusion criteria. Most patients underwent VP shunt placement (16 [71.4%]). Patients who underwent surgical management of NEC compared with those who underwent medical management were more likely to have a VA shunt placed (p = 0.02). One VA shunt and 3 VP shunts became infected during follow-up (p = 0.7). The mean time until infection was not significantly different between VA and VP shunts (p = 0.73). Significantly more VA shunts required revision (83% vs 31%, p = 0.04), and VA shunts had a significantly shorter time until failure (3.0 ± 0.8 vs 46.3 ± 7.55 months, p = 0.03).
CONCLUSIONS
VP shunts had a significantly longer time until failure than VA shunts; these shunts had similar infection rates in infants with prior NEC. When feasible, neurosurgeons and pediatric general surgeons can consider placing a VP shunt even if the patient has a history of NEC.
PierroA,ManalangLR,MayPL,CookeRW,CudmoreRE,LloydDA.Necrotizing enterocolitis complicating the management of posthemorrhagic hydrocephalus.J Pediatr Surg.1993;28(8):982–985.
AlganabiM,LeeC,BindiE,LiB,PierroA.Recent advances in understanding necrotizing enterocolitis.F1000Res.2019;8(F1000 Faculty Rev):107.
Alganabi
M
,
Lee
C
,
Bindi
E
,
Li
B
,
Pierro
A
.
Recent advances in understanding necrotizing enterocolitis
.F1000Res
.
2019
;
8
(
F1000 Faculty Rev
):
107
.)| false
Stoll
BJ
,
Hansen
NI
,
Bell
EF
,
Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012
.JAMA
.
2015
;
314
(
10
):
1039
–
1051
.
26348753)| false
ChristianEA,JinDL,AttenelloF,et al.Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000-2010.J Neurosurg Pediatr.2016;17(3):260–269.
Christian
EA
,
Jin
DL
,
Attenello
F
,
Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000-2010
.J Neurosurg Pediatr
.
2016
;
17
(
3
):
260
–
269
.
26544084)| false
HorbarJD,BadgerGJ,CarpenterJH,et al.Trends in mortality and morbidity for very low birth weight infants, 1991-1999.Pediatrics.2002;110(1 Pt 1):143–151.
Philip
AG
,
Allan
WC
,
Tito
AM
,
Wheeler
LR
.
Intraventricular hemorrhage in preterm infants: declining incidence in the 1980s
.Pediatrics
.
1989
;
84
(
5
):
797
–
801
.
2677959)| false
KeucherTR,MealeyJJr.Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus.J Neurosurg.1979;50(2):179–186.
RymarczukGN,KeatingRF,CoughlinDJ,et al.A comparison of ventriculoperitoneal and ventriculoatrial shunts in a population of 544 consecutive pediatric patients.开云体育app官方网站下载入口.2020;87(1):80–85.
Rymarczuk
GN
,
Keating
RF
,
Coughlin
DJ
,
A comparison of ventriculoperitoneal and ventriculoatrial shunts in a population of 544 consecutive pediatric patients
.开云体育app官方网站下载入口
.
2020
;
87
(
1
):
80
–
85
.)| false
LittleJR,RhotonALJr,MellingerJF.Comparison of ventriculoperitoneal and ventriculoatrial shunts for hydrocephalus in children.Mayo Clin Proc.1972;47(6):396–401.
Little
JR
,
Rhoton
AL
Jr
,
Mellinger
JF
.
Comparison of ventriculoperitoneal and ventriculoatrial shunts for hydrocephalus in children
.Mayo Clin Proc
.
1972
;
47
(
6
):
396
–
401
.
5041686)| false
de OliveiraRS,BarbosaA,VicenteYA,MachadoHR.An alternative approach for management of abdominal cerebrospinal fluid pseudocysts in children.Childs Nerv Syst.2007;23(1):85–90.
de Oliveira
RS
,
Barbosa
A
,
Vicente
YA
,
Machado
HR
.
An alternative approach for management of abdominal cerebrospinal fluid pseudocysts in children
.Childs Nerv Syst
.
2007
;
23
(
1
):
85
–
90
.
16944175)| false
Gmeiner
M
,
Wagner
H
,
van Ouwerkerk
WJR
,
Senker
W
,
Holl
K
,
Gruber
A
.
Abdominal pseudocysts and peritoneal catheter revisions: Surgical long-term results in pediatric hydrocephalus
.World Neurosurg
.
2018
;
111
:
e912
–
e920
.
29325961)| false
SymssNP,OiS.有一个理想并联?110 y的全景ears in CSF diversions and shunt systems used for the treatment of hydrocephalus: from historical events to current trends.Childs Nerv Syst.2015;31(2):191–202.
Symss
NP
,
Oi
S
.
有一个理想并联?110 y的全景ears in CSF diversions and shunt systems used for the treatment of hydrocephalus: from historical events to current trends
.Childs Nerv Syst
.
2015
;
31
(
2
):
191
–
202
.
25547875)| false
Vernet
O
,
Campiche
R
,
de Tribolet
N
.
Long-term results after ventriculo-atrial shunting in children
.Childs Nerv Syst
.
1995
;
11
(
3
):
176
–
179
.
7773980)| false
Vernet
O
,
Campiche
R
,
de Tribolet
N
.
Long-term results after ventriculoatrial shunting in children
.Childs Nerv Syst
.
1993
;
9
(
5
):
253
–
255
.
8252512)| false
EllisH,MoranBJ,ThompsonJN,et al.Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study.Lancet.1999;353(9163):1476–1480.
ten Broek
RP
,
Issa
Y
,
van Santbrink
EJ
,
Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis
.BMJ
.
2013
;
347
:
f5588
.
24092941)| false
ErpsA,RothJ,ConstantiniS,Lerner-GevaL,Grisaru-SoenG.Risk factors and epidemiology of pediatric ventriculoperitoneal shunt infection.Pediatr Int (Roma).2018;60(12):1056–1061.
Erps
A
,
Roth
J
,
Constantini
S
,
Lerner-Geva
L
,
Grisaru-Soen
G
.
Risk factors and epidemiology of pediatric ventriculoperitoneal shunt infection
.Pediatr Int (Roma)
.
2018
;
60
(
12
):
1056
–
1061
.)| false
McGirtMJ,ZaasA,FuchsHE,GeorgeTM,KayeK,SextonDJ.Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens.Clin Infect Dis.2003;36(7):858–862.
HauptmanJS,KestleJ,Riva-CambrinJ,et al.Predictors of fast and ultrafast shunt failure in pediatric hydrocephalus: a Hydrocephalus Clinical Research Network study.J Neurosurg Pediatr.2020;27(3):277–286.
BeckerDP,NulsenFE.Control of hydrocephalus by valve-regulated venous shunt: avoidance of complications in prolonged shunt maintenance.J Neurosurg.1968;28(3):215–226.
HungAL,Vivas-BuitragoT,AdamA,et al.Ventriculoatrial versus ventriculoperitoneal shunt complications in idiopathic normal pressure hydrocephalus.Clin Neurol Neurosurg.2017;157:1–6.
Hung
AL
,
Vivas-Buitrago
T
,
Adam
A
,
Ventriculoatrial versus ventriculoperitoneal shunt complications in idiopathic normal pressure hydrocephalus
.Clin Neurol Neurosurg
.
2017
;
157
:
1
–
6
.
28347957)| false
BruinsmaN,StobberinghEE,HerpersMJ,VlesJS,WeberBJ,GavilanesDA.Subcutaneous ventricular catheter reservoir and ventriculoperitoneal drain-related infections in preterm infants and young children.Clin Microbiol Infect.2000;6(4):202–206.
Bruinsma
N
,
Stobberingh
EE
,
Herpers
MJ
,
Vles
JS
,
Weber
BJ
,
Gavilanes
DA
.
Subcutaneous ventricular catheter reservoir and ventriculoperitoneal drain-related infections in preterm infants and young children
.Clin Microbiol Infect
.
2000
;
6
(
4
):
202
–
206
.)| false
KaestnerS,FraijA,FassJ,DeinsbergerW.Ventriculoperitoneal shunt infections cause acute abdomen and peritonitis: a case series.J Surg Res.2020;248:153–158.
Kaestner
S
,
Fraij
A
,
Fass
J
,
Deinsberger
W
.
Ventriculoperitoneal shunt infections cause acute abdomen and peritonitis: a case series
.J Surg Res
.
2020
;
248
:
153
–
158
.
31901642)| false
SpaderHS,HertzlerDA,KestleJR,Riva-CambrinJ.Risk factors for infection and the effect of an institutional shunt protocol on the incidence of ventricular access device infections in preterm infants.J Neurosurg Pediatr.2015;15(2):156–160.
Spader
HS
,
Hertzler
DA
,
Kestle
JR
,
Riva-Cambrin
J
.
Risk factors for infection and the effect of an institutional shunt protocol on the incidence of ventricular access device infections in preterm infants
.J Neurosurg Pediatr
.
2015
;
15
(
2
):
156
–
160
.
25479576)| false
BrockmeyerDL,WrightLC,WalkerML,WardRM.Management of posthemorrhagic hydrocephalus in the low-birth-weight preterm neonate.Pediatr Neurosci.1989;15(6):302–308.
RichardE,CinalliG,AssisD,Pierre-KahnA,Lacaze-MasmonteilT.Treatment of post-haemorrhage ventricular dilatation with an Ommaya’s reservoir: management and outcome of 64 preterm infants.Childs Nerv Syst.2001;17(6):334–340.
Richard
E
,
Cinalli
G
,
Assis
D
,
Pierre-Kahn
A
,
Lacaze-Masmonteil
T
.
Treatment of post-haemorrhage ventricular dilatation with an Ommaya’s reservoir: management and outcome of 64 preterm infants
.Childs Nerv Syst
.
2001
;
17
(
6
):
334
–
340
.
11417413)| false
Choux
M
,
Genitori
L
,
Lang
D
,
Lena
G
.
Shunt implantation: reducing the incidence of shunt infection
.J Neurosurg
.
1992
;
77
(
6
):
875
–
880
.
1432129)| false
