Ventriculoperitoneal shunts in low birth weight infants with intracranial hemorrhage

Subcutaneous ventricular catheter reservoir and ventriculoperitoneal drain-related infections in preterm infants and young children

“…Choux et al (Table 3) [11] especially described a very low infection rate, but they neither mentioned the age at which surgery was performed, nor the incidence of posthemorrhagic hydrocephalus in the group of 73 preterm infants. Initial placement, early in the postnatal period, has a significantly higher infection risk than a later placement [10]. This is confirmed by our data.…”

“…This is probably due to the unstable, immature state of the patients, the low birth weight, the high number of skin bacteria [4] and the often long hospitalization which causes more colonization with specific nosocomial microorganisms [4,14,15]. In general, preterm infants with posthemorrhagic hydrocephalus were treated with a temporary VCR, because of the high CSF-protein concentration and possible blood clots which could obstruct a primarily placed definitive VPD [10]. According to the study of Benzel et al (1993), early placement of a VCR was associated with a decrease in the overall shunt infection rate, which is substantial in preterm infants [3].…”

“…The percentage of shunt infections ranged in several retrospective studies from 0.17 to 39% [1][2][3][4][5][6][7][8][9][10][11][12]. In patients with subcutaneous ventricular catheter reservoirs (VCR) or ventriculoperitoneal drains (VPD), the variations in infection rate are probably due to differences in the age of the patients, definition of infection, study methodology and peri-operative measures.…”

“…Shunt infections are associated with many factors, including among others, age and weight of the patient, experience of the neurosurgeon, place of surgery (intensive care unit or operating room), duration of surgery, type of shunt, and use and duration of prophylactic antibiotics [1,4,7,10,13].…”

An adjustable gravitational valve for initial VP-shunt treatment in hydrocephalic preterm neonates and infants below 1 year of age

“…The aim of the study was to evaluate safety and feasibility for the primary use of an adjustable gravitational device combined with a fixed differential pressure valve in an extremely vulnerable subgroup of very young pediatric hydrocephalus patients. Young age and a history of prematurity, especially a high incidence of IVH-related PHHC, anticipate a comparatively higher risk of early or repeated shunt failures [ 5 , 6 , 31 , 37 , 38 ] due to mechanical complications by delicate thin galeal structures, difficult skin closure, and potential risk of catheter migration by concurrent body growth. Of great importance are valve obstructions with extracellular matrix proteins which are highly expressed following denudated ventricular walls with astrocytic scar proliferations [ 39 ] In accordance with these circumstances valve materials and shunt management options suitable for this challenging environment and the avoidance of over-drainage during this highly vulnerable period is mandatory.…”