title: Management of neonatal hydrocephalus: feasibility of use and safety of two programmable (Sophy and Polaris) valves.
abstract: BACKGROUND
  Neonates represent a unique group of pediatric patients with special peculiarities. Hydrocephalus valves have not always been designed to meet the requirements of these small children. Few series have addressed the problem of cerebrospinal fluid shunting in newborn babies.
  
  
  OBJECTIVE
  We aimed (1) to evaluate the feasibility of the use of two programmable valves (Sophy and Polaris) in hydrocephalic neonates and (2) to ascertain complications and safety issues arising from their use.
  
  
  METHODS
  We performed a prospective study of 100 consecutive preterm and term babies (<2 months of age) given a programmable valve. Valves' settings were readjusted at different pressure levels as required. Outcomes were obtained from the records of our Outpatient Clinic.
  
  
  RESULTS
  The study group was formed by 60 term and 40 preterm infants (average weight 2,440 g, mean age of 25 days). Mean follow-up was 55 months. Only one fifth deaths was shunt-related. In 70 babies, no complications occurred, and hydrocephalus was successfully controlled. Proximal catheter obstruction presented in 20% and infection in 5% of cases. Several external adjustments of the valves apparently avoided several surgical shunt revisions.
  
  
  CONCLUSIONS
  (1) Both programmable valves (Sophy and Polaris) can be safely used for treatment of neonatal hydrocephalus, introducing some technical modifications. (2) Both valves are comparable to other shunts with regard to indications, performance, and safety. (3) The possibility of modifying their working pressure seems to constitute their main advantage. Prevention of late overdrainage syndromes with these valves needs a longer follow-up.
authors.affiliation: Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar, 30120 Murcia, Spain. juanf.martinezlage@cablemurcia.com
authors.forename: Juan F
authors.initials: JF
authors.lastname: Martínez-Lage
authors.forename: María-José
authors.initials: MJ
authors.lastname: Almagro
authors.forename: Isabel Sanchez
authors.initials: IS
authors.lastname: Del Rincón
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Pérez-Espejo
authors.forename: Claudio
authors.initials: C
authors.lastname: Piqueras
authors.forename: Raúl
authors.initials: R
authors.lastname: Alfaro
authors.forename: Javier
authors.initials: J
authors.lastname: Ros de San Pedro
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012984:Software; D013525:Surgical Instruments; D014056:Tomography, X-Ray