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Purpose To gain insight into the patient characteristics of surgically treated hydrocephalus in the Netherlands, we report the first data from the Dutch Quality Registry NeuroSurgery (QNRS) database for infants with hydrocephalus requiring surgical intervention. Methods We used the prospectively gathered database concerning infants ≤ 2 years of age surgically treated for hydrocephalus. We report data from start of registry, concerning etiology, age, and treatment of patients registered. We compared data with the Hydrocephalus Clinical Research Network (HCRN), a multicenter network of pediatric neurosurgical institutions in North America.Results A total of 359 operated infants was registered in the period from 2010 to 2017. A drop in patients registered was seen in 2015, possibly due to revisions of the database. Most infants were operated on between 1 and 6 months of age. Cause of hydrocephalus was predominantly intracranial hemorrhage, followed by congenital causes. The proportion of infants with aqueduct stenosis and myelomeningocele as cause of hydrocephalus stayed relatively stable during this period of registration. Initial shunting was performed in 40% and reservoir/ETV as initial treatment was done in 60%. In both groups, 50% needed revision surgery. Conclusions The first data concerning surgically treated pediatric hydrocephalus from a prospectively collected Dutch register are presented, showing similar results when comparing to the HCRN database.

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Evaluation of: Whitelaw A, Jary S, Kmita G et al.: Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years. Pediatrics 125, E852–E858 (2010). The aim of the study was to determine in a randomized trial whether ventricle drainage, irrigation and fibrinolytic therapy (DRIFT) altered the rate of death or severe neurodevelopmental disability at 24 months’ corrected age in preterm infants with posthemorrhagic ventricular dilatation. Of the children assigned to DRIFT, 54% died or were severely disabled, versus 71% in the standard group. Among the survivors, 31% in the DRIFT group had severe cognitive disability (Mental Development Index score <55) versus 59% in the standard group. No differences were found in rates of children with Mental Development Index scores over 70. The study points to a potential meaningful intervention by removing toxic substances from hemorrhagic cerebrospinal fluid. Being a highly invasive intervention, however, further studies are required.

Objective: Preterm infants are at risk for intracranial haemorrhage with subsequent hydrocephalus. Post-haemorrhagic hydrocephalus is associated with poor outcome but little is know about the long-term outcome at school-age. Our aim was to determine the cognitive outcome in children with post-haemorrhagic hydrocephalus at school-age. Methods:We included infants treated at the NICU in Groningen with post-haemorrhagic hydrocephalus, born between 1996 and 2003. We reviewed the medical charts for neonatal characteristics and interventional surgery. We determined intelligence (WISC-III-NL), attention (Test of Everyday Attention in Children), and verbal memory (Auditory Verbal Learning Test). Results:We included 28 children (18 boys, 10 girls), median gestational age 29 weeks (range 25-40) and birth weight 1355 grams (880-3810). Seven children died in infancy. Eleven children of 21 survivors required surgical intervention. At follow-up (median age 11y, [6][7][8][9][10][11][12][13][14]), 2 children had severe cerebral palsy and were not able to perform cognitive testing. Median total IQ was 88 (59-110) with verbal IQ 88 (62-128) and performance IQ 88 (52-112). Attention scores were normal in 6 (>P15), subclinical (P5-P15) in 1, and abnormal (< P5) in 7 children. Verbal memory was normal in 13, subclinical in 2, and abnormal in 2 children. There was no difference in cognitive scores between children requiring intervention and not. Conclusion:Children with post-haemorrhagic hydrocephalus have approximately 0.8 SD lower scores on IQ than the norm population. Attention was affected in more than half of the children, verbal memory seemed less affected. Surgical intervention for hydrocephalus was not associated with cognitive outcome. Methods: Placental pathology and relevant clinical data were obtained from consecutively born singleton infants (gestational age < 32 wks) in the Erasmus MC. Prediction models for histological chorioamnionitis (HC) and for HC with fetal involvement (FI) were constructed using clinical variables known at birth, in a backward logistic regression model. ROC curves were computed using model-derived predictives.Results: Of the 216 included infants 84 had HC, of whom 51 had FI. HC+FI was best predicted by a combination of low gestational age, clinical chorioamnionitis, PPROM, absence of preeclampsia and not being small for gestational age (Table 1; AUC(95%CI)=0.93(0.89-0.96), p< .001). HC was best predicted by the same model with addition of placental weight (Table 2; AUC(95%CI)=0.95(0.93-0.98); p< .001). At a set specificity of 90%, sensitivity of the model is 82% for HC+FI and 85% for HC.[Tables]