title: Risk of ventriculoperitoneal shunt infections due to gastrostomy feeding tube insertion in pediatric patients with brain tumors.
abstract: OBJECTIVE
  To determine the risk of ventriculoperitoneal (VP) shunt infections after percutaneous retrograde gastrostomy feeding tube (GT) placement in children with brain tumors.
  
  
  METHODS
  All children (age 0-18 years) with primary brain tumors diagnosed and treated at the Hospital for Sick Children, Toronto, Canada, were subjected to a retrospective analysis. Two groups were identified: the study group included children with a VP shunt and a GT; the control group included children with VP shunts only. Each study patient was matched with 2 controls to compare the rate of infections (cohort comparative study).
  
  
  RESULTS
  There were 1,167 children diagnosed and treated with primary brain tumors during the study period (1988-2003); 174 (15%) had a VP shunt and 23 (2%) children had both, a VP shunt and a GT. In the study group (n=17), GTs were inserted at a median time of 80 days (range 6-204 days) after VP shunts. VP shunt infection rate was 23.5% (4/17) compared to 8.8% (3/34) in the control group (OR 3.18; 95% CI 0.622-16.54, p=0.16). Three (75%) of the infection episodes in the study group presented with an ascending VP shunt infection directly related to the GT insertion or manipulation in the first 6 weeks. These GTs were inserted at 13, 47 and 49 days after VP shunt insertion.
  
  
  CONCLUSIONS
  Placement of percutaneous retrograde GTs, in the acute phase, in children with brain tumors and VP shunts may increase the risk of ascending meningitis especially if there are early GT-related complications.
authors.affiliation: Division of Pediatric Neuro-Oncology, Hospital for Sick Children, University of Toronto, Toronto, Canada. adam.gassas@sickkids.ca
authors.forename: A
authors.initials: A
authors.lastname: Gassas
authors.forename: J
authors.initials: J
authors.lastname: Kennedy
authors.forename: G
authors.initials: G
authors.lastname: Green
authors.forename: B
authors.initials: B
authors.lastname: Connolly
authors.forename: J
authors.initials: J
authors.lastname: Cohen
authors.forename: U
authors.initials: U
authors.lastname: Dag-Ellams
authors.forename: A
authors.initials: A
authors.lastname: Kulkarni
authors.forename: E
authors.initials: E
authors.lastname: Bouffet
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000209:etiology*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*