The Incidence of Central Nervous System Infection Post Ventriculoperitoneal Shunt Insertion among KASCH-RYD Pediatric Patients over 20 Years period

Alnazer Z, Hussain MAM, Alshareef M, Alhamzah A, Aljohani A, Azzubi M and Alalola S

Published on: 2021-06-30

Abstract

Background: Surgical insertion of a ventriculoperotineal (VP) shunt is the standard treatment of hydrocephalus. However, shunt infection is a major complication, and might lead to many complications.

Methods: A retrospective case series study was performed on 700 randomly selected pediatric patients to identify the incidence of infection post VP shunt surgery from 1997- 2017 in King Abdullah Specialized Children Hospital (KASCH), Riyadh, Saudi Arabia.

Patients aged 0 - 14 years old who had their VP shunt surgery at KASCH were included. Patient who underwent any other neurological procedure one year prior to the VP shunt, patient with any missing data, and patient with immunodeficiencies were excluded. P-value of less than 0.05 was considered statistically significant, with a 95% confidence interval.

Results: Out of 172 included patients, 55.8% were females, and the majority (66.3%) were full-term babies. Preoperative prophylactic antibiotics were prescribed in 79.1% of the cases. Infection accounted for 9.3% with a mean symptoms onset time of 1.3 (±2.5) months post-operatively. Other post-operative complications found were; malfunction (21.5%), obtrusions (4.1%) and hemorrhage (0.6%). Pre-term gestational age reported a significant increase in infection incidence compared to other post-surgical outcomes with a percentages of 10.3%. Age and weight at surgery, and weight at birth were significantly associated with an increase in post-operative complications with p-values of 0.035, 0.043 and 0.022 respectively. Low birth weight was significantly associated with mortality with a p-value of 0.019.

Conclusion: The incidence of infections post VP shunt in this study was 9.3% with a mean symptoms onset time of 1.3(±2.5) months post-operatively. Gestational age, age and weight at surgery were identified as the major risk factors for post-operative complications. Further studies to identify what makes pediatric patients more susceptible for infections post VP shunt surgery are needed.