Behjati Shahin, Emami-Naeini Parisa, Nejat Farideh, El Khashab Mostafa
Department of Neonatology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Childs Nerv Syst. 2011 Jun;27(6):985-9. doi: 10.1007/s00381-010-1387-4. Epub 2011 Jan 14.
To investigate the associated risk factors for ventriculoperitoneal (VP) shunting in infantile hydrocephalus following intraventricular hemorrhage (IVH) in premature infants.
A historical cohort study was conducted, consisting of 97 premature infants in whom the diagnosis of IVH was previously made by cranial ultrasound and were referred to pediatric neurosurgery clinic and/or neonatal intensive care unit of Children's Hospital Medical Center in Tehran, Iran, from April 2004 to March 2009. Among the patients, those who were followed up for at least 6 months after the diagnosis of IVH were included in the study, and data regarding signs and symptoms of increased intracranial pressure, cranial ultrasound, non-surgical treatment (CSF drainage and/or acetazolamide), and shunt requirement were extracted. Patients who required VP shunting were followed up for at least 6 months thereafter considering shunt infection.
All the patients were followed up for at least 1 year, except for three who died at the ages of 6 (two of them) and 7 months. Thirty five percent (35%) of patients required VP shunting, in all of whom IVH was of grade 3 or 4. The need for VP shunting in these patients was predicted only by the severity of IVH. Non-surgical treatments for IVH had no statistically significant effect on shunt requirement. Moreover, 11 of 31 patients with shunt developed shunt infection, which was significantly associated with repeated cerebrospinal fluid (CSF) drainage.
It is suggested that children with IVH, especially of higher grades, should be followed up meticulously (by signs, symptoms, and periodic cranial ultrasounds). Non-surgical treatments are considered for patients requiring VP shunting who are not good candidates for immediate surgical intervention. The only predictor for surgical intervention was the grade of IVH.
探讨早产儿脑室内出血（IVH）后婴儿脑积水行脑室腹腔（VP）分流术的相关危险因素。
进行一项历史性队列研究，研究对象为97例早产儿，这些早产儿先前经头颅超声诊断为IVH，并于2004年4月至2009年3月转诊至伊朗德黑兰儿童医院医学中心的儿科神经外科诊所和/或新生儿重症监护病房。在这些患者中，将IVH诊断后至少随访6个月的患者纳入研究，并提取有关颅内压升高的体征和症状、头颅超声、非手术治疗（脑脊液引流和/或乙酰唑胺）以及分流需求的数据。此后，对需要VP分流术的患者随访至少6个月，同时考虑分流感染情况。
除3例分别在6个月（2例）和7个月时死亡外，所有患者均至少随访1年。35%的患者需要VP分流术，所有这些患者的IVH均为3级或4级。这些患者对VP分流术的需求仅由IVH的严重程度预测。IVH的非手术治疗对分流需求无统计学显著影响。此外，31例接受分流术的患者中有11例发生分流感染，这与反复脑脊液（CSF）引流显著相关。
建议对IVH患儿，尤其是较高分级的患儿，应进行细致随访（通过体征、症状和定期头颅超声）。对于需要VP分流术但不适合立即进行手术干预的患者，可考虑非手术治疗。手术干预的唯一预测因素是IVH的分级。
