Antibiotic impregnated and non antibiotic impregnated ventriculoperitoneal shunts in neonatal myelomeningocele associated with hydrocephalus, Is there a valuable difference?

Abstract

Background: Myelomeningocele (MMC) is a congenital defect of the central nervous system that inflicts a great burden on the patients and the healthcare system. Treatment of MMC involves placement of ventriculoperitoneal (VP) shunts for the associated hydrocephalus. The use of VP shunt is associated with potential complications such as shunt-related infections and shunt failures. The effectiveness of antibiotic-impregnated shunts to reduce the incidence of shunt infections is still debated.Objective: This study aimed to compare the outcomes following insertion of antibioticimpregnated versus nonantibiotic-impregnated ventricular and peritoneal shunts of the same type in cases of early postnatal surgical repair of myelomeningocele associated with hydrocephalus.Methods: Neonates presented after antenatal or after birth diagnosis of MMC, associated with clinical and radiological evidence of hydrocephalus, who were scheduled for early surgical intervention within 48 h after birth were included. Those with mild hydrocephalus, and full-thickness skin covering the MMC sac that can be managed as elective surgery were excluded. During surgery, patients were to either managed with antibiotic-impregnated both ventricular and peritoneal (VP) shunt (Group A, N= 12), or nonantibiotic-impregnated VP shunt of the same type (Group B, N=13). In both groups, the incidence of shunt infection and wound dehiscence, the type of wound management, duration of antibiotic prophylaxis, the need for a secondary procedure, operative time, and hospital stay were assessed. Results:The incidence of infection and partial wound dehiscence was non-significantly lower in group A than in group B (16.7% versus 30.8%, p=0.645). Two (16.7%) patients in group A required antibiotic use for more than 5 days compared with 4 (30.8%) patients in group B, with no significant difference (p=0.645). One patient in each group needed meticulous dressing and follow-up (8.3% versus 7.7%), whereas in between stitches and care was required in only 1 (8.3%) patient in group A compared with 3 (23.1%) patients in group B, with no significant difference. (p=0.787). Conclusions:The findings indicate comparable outcomes of antibiotic-impregnated shunts compared to nonantibiotic-impregnated ones. Compared with AIS, non-AIS showed a non-33 significant reduction in shunt and CSF infection rates, which was noted with the use of AI systems.