Objective To identify factors related to ventricular-peritoneal shunt (VPS) complications in pediatric patients at a high-risk maternity hospital. Methods Prospective study, conducted between September/2018 and June/2019, with selected newborns without previous ventricular bypass who underwent neurosurgery for VPS placement in a high-risk maternity hospital in the state of Sergipe, Brazil. Diagnosis of hydrocephalus occurred by transfontanelle ultrasound. The variables were analyzed by Student t-test, adopting p < 0.05 as statistical significance. Results Seven newborns participated in the study, 3 male and 4 female. Folic acid supplementation during pregnancy was considered a positive influencing factor in the 1st minute Apgar. Hydrocephalus secondary to premature hemorrhage was present in most newborns. Prematurity, 1st minute Apgar score < 7, and birth weight < 2,500 g did not represent a significant negative risk factor for prolonged hospitalization after neurosurgery. One newborn had cerebrospinal fluid infection and was the only one with heart disease. Conclusion This is the first scientific research that associates the benefits of maternal use of folic acid during pregnancy to better newborn Apgar scores. Only one newborn developed complications after neurosurgery, the only one with an associated comorbidity. Further studies are needed to provide more evidence on risk factors related to complications of VPS implantation in newborns. This neurosurgical procedure in a high-risk maternity contributed to the early management of hydrocephalus.
Objetivo: Evaluar distribución, presentación clínica inicial y tasa de supervivencia de los niños con tumores del sistema nervioso central tratados en capital de la región nordeste de Brasil. Método: Estudio prospectivo que involucra a pacientes menores de 19 años admitidos entre julio/2011 y julio/2013. Resultados: La incidencia media anual aproximada de tumores pediátricos del SNC en Sergipe fue de 22,4 casos por cada 1.000.000 niños y adolescentes por año. El promedio de edad fue 7,68 años, siendo el 67,6% de pacientes del sexo femenino y el 76,5% de no blancos. La cefalea y los vómitos estuvieron presentes en la admisión en el 79,4%, en su mayoría con déficits neurológicos. El cerebelo fue la estructura anatómica más afectada (32,4%). La localización infratentorial fue observada en el 50% de los casos. Las morbilidades asociadas fueron más frecuentes en el compartimiento supratentorial (p = 0,015) y las categorías histológicas más frecuentes fueron astrocitoma pilocítico (23,5%), glioma difuso de puente (17,6%) y 11,8% meduloblastoma, craneofaringioma, ependimoma, cada uno. La resección quirúrgica fue posible en el 70,5% de los casos, en la mayoría sin terapia adyuvante. La upervivencia después de 12 meses fue el 72,8% y después de 24 meses, el 37%. Conclusión: La muestra posee características demográficas, histopatológicas, clínicas y supervivencia a 12 meses semejantes a la literatura. La caída de la supervivencia a los 24 mesespuede reflejar la participación de los tumores de tronco encontrados en nuestra muestra.
No abstract
RESUMOA derivação ventriculoperitoneal (DVP) tem sido o tratamento cirúrgico de escolha mais comum no controle da hidrocefalia. Este procedimento não é isento de complicações. O nó espontâneo no cateter peritoneal tem sido considerado uma complicação rara. O mecanismo exato desta complicação permanece desconhecido. Dentre as prováveis causas desta complicação estão peristaltismo intestinal, elasticidade do material do shunt, comprimento do cateter e técnica cirúrgica. Os autores relatam um caso de nó espontâneo no cateter peritoneal em uma criança que apresentou hipertensão intracraniana, sendo submetida a retirada do sistema e instalação de um novo cateter, que cursou com bom prognóstico. Palavras-chave: Derivação ventriculoperitoneal; Complicação de shunt; Mau funcionamento de shunt; Nó cateter peritoneal;ABSTRACT The ventriculoperitoneal shunt (VPS ) has been the choice surgical treatment in controlling hydrocephalus. This procedure is not without complications. The Spontaneous node in the peritoneal catheter has been considered a rare complication. The exact mechanism of this complication remains unknown. Among the probable causes of this complication are intestinal peristalsis, the shunt material elasticity, the catheter length and surgical technique. The authors report a case of spontaneous node in the peritoneal catheter in a child who had intracranial hypertension, and subjected to removal of the system and installation of a new catheter, which he attended with a good prognosis.
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