Pediatric Hydrocephalus in Brazil Public Health System: the Reality of a Developing Country in the Past 13 Years

Abstract

PURPOSE Pediatric hydrocephalus is a significant challenge in neurosurgery, particularly in resource-limited settings. This study focuses on the landscape of pediatric hydrocephalus neurosurgery in Brazil, a developing country, over the past 13 years. METHODS Data were collected from the Brazilian Hospital Information System, Live Birth Information System, and Mortality Information System records in the DATASUS (Departamento de Informática do SUS) database among January 2008 and the July 2021. Various health indicators were analyzed, including hospitalizations, treatment options, costs, and mortality rates. RESULTS During the period of study, Brazil recorded 8,493 new diagnoses of congenital hydrocephalus in live births, with 1,123 cases associated with spina bifida. The prevalence of congenital hydrocephalus was 241 cases per 100,000 live births, and 210 cases per 100,000 live births were attributed to congenital hydrocephalus not related to spina bifida. A total of 730 perinatal mortality cases related to congenital hydrocephalus were reported, with no clear trend over the 12-year period. The average number of perinatal mortality cases was 60.83 ± 13.98 per year. There were 1,063 infant mortality cases associated with hydrocephalus and 3,122 cases associated with congenital hydrocephalus, with no clear trend observed. The highest mortality rates for both diagnoses occurred between 3 to 5 months of age. Ethnicity and age were found to have significant relationships with mortality rates. A total of 217,900 hydrocephalus-related procedures were performed, with an increase in mean hospitalization cost and procedure numbers over the 13-year period. Mean cost per procedure had a significant negative effect on mean length of stay, while average professionals' salary did not have a significant effect. CONCLUSION Pediatric hydrocephalus in Brazil's public health system is a significant burden. Congenital hydrocephalus prevalence and mortality rates emphasize the need for better diagnosis and treatment. Early diagnosis, prenatal care, and adequate resources are crucial. This study offers insights into pediatric hydrocephalus in a developing country, highlighting challenges and future directions for improved care.