One year failure rates for de-novo ventriculo-peritoneal shunts in under 3-month-old children

<b>Introduction:</b> Ventriculo-peritoneal shunts (VPS) are still the mainstay treatment for hydrocephalus in children. It is generally accepted that VPS failure and infection rates are higher for neonates than for older children. We compared our 1-year failure and infection rates in under 3-month-old children compared with older children in our department. <b>Results:</b> We identified 58 children under 3 months of age who underwent VPS insertion between January 2007 and December 2016. They had a 29.3% (17) shunt failure rate over the first year. There were two confirmed shunt infections (3.4%). <b>Discussion:</b> The 1-year shunt failure rate at our institution for VPS insertion in children over 3 months is 26.1% and the infection rate is 4.3% (9). The literature suggests that the outcome for VPS in younger children is worse than for older children. Our work shows similar outcomes for all children compared to those under 3 months at time of VPS insertion alone. <b>Conclusion:</b> Children under 3-months-old undergoing VPS insertion should not automatically expect an increased 1-year failure or infection rate compared with older children. The reasons for this may be as a result of increased subspecialisation, the more widespread use of antibiotic-impregnated catheters and improved neonatal care.

引言：脑室腹腔分流术（Ventriculo-peritoneal shunts, VPS）仍是儿童脑积水的主流治疗手段。学界普遍认为，新生儿的VPS失败率与感染率均高于年长儿童。本研究对比了我科收治的3月龄以下儿童与年长儿童接受VPS术后1年的失败率与感染率。结果：本研究纳入2007年1月至2016年12月期间接受VPS置入术的58名3月龄以下儿童。该组儿童术后1年内的分流失败率为29.3%（共17例），其中确诊分流道感染2例，占比3.4%。讨论：我科对3月龄以上儿童实施VPS置入术后1年的分流失败率为26.1%，感染率为4.3%（共9例）。现有文献表明，低龄儿童接受VPS术后的预后差于年长儿童，但本研究结果显示，仅就VPS置入术后1年的预后而言，3月龄以下儿童与年长儿童并无显著差异。结论：与年长儿童相比，接受VPS置入术的3月龄以下儿童，无需默认其术后1年的失败率或感染率会更高。该结果的潜在原因可能包括：亚专科诊疗精细化程度提升、抗生素涂层导管的普及应用，以及新生儿护理水平的改进。