title: A multicenter retrospective comparison of conversion from temporary to permanent cerebrospinal fluid diversion in very low birth weight infants with posthemorrhagic hydrocephalus.
abstract: OBJECTIVE
  The purpose of this study was to define the incidence of permanent shunt placement and infection in patients who have undergone the 2 most commonly performed temporizing procedures for posthemorrhagic hydrocephalus (PHH) of prematurity: ventriculosubgaleal (VSG) shunt placement and ventricular reservoir placement for intermittent tapping.
  
  
  METHODS
  The 4 centers of the Hydrocephalus Clinical Research Network participated in a retrospective chart review of infants with PHH who underwent treatment at each institution between 2001 and 2006. Patients were included if they had received a diagnosis of Grade 3 or 4 intraventricular hemorrhage, weighed < 1500 g at birth, and had received surgical intervention. The authors determined the incidence of conversion from a temporizing device to a permanent shunt, the incidence of CSF infection during temporization, and the 6-month CSF infection rate after permanent shunt placement.
  
  
  RESULTS
  Thirty-one (86%) of 36 patients who received VSG shunts and 61 (69%) of 88 patients who received ventricular reservoirs received permanent CSF diversion with a shunt (p = 0.05). Five patients (14%) in the VSG shunt group had CSF infections during temporization, compared with 11 patients (13%) in the ventricular reservoir group (p = 0.83). The 6-month incidence of permanent shunt infection in the VSG shunt group was 16% (5 of 31), compared with 12% (7 of 61) in the reservoir placement group (p = 0.65). For the first 6 months after permanent shunt placement, infants with no preceding temporizing procedure had an infection rate of 5% (1 of 20 infants) and those who had undergone a temporizing procedure had an infection rate of 13% (12 of 92; p = 0.45).
  
  
  CONCLUSIONS
  The use of intermittent tapping of ventricular reservoirs in this population appears to lead to a lower incidence of permanent shunt placement than the use of VSG shunts. The incidence of infection during temporization and for the initial 6 months after conversion appears comparable for both groups. The apparent difference identified in this pilot study requires confirmation in a more rigorous study.
authors: Section of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama at Birmingham, Alabama 35233, USA. jay.wellons@ccc.uab.edu
authors: John C
authors: JC
authors: Wellons
authors: Chevis N
authors: CN
authors: Shannon
authors: Abhaya V
authors: AV
authors: Kulkarni
authors: Tamara D
authors: TD
authors: Simon
authors: Jay
authors: J
authors: Riva-Cambrin
authors: William E
authors: WE
authors: Whitehead
authors: W Jerry
authors: WJ
authors: Oakes
authors: James M
authors: JM
authors: Drake
authors: Thomas G
authors: TG
authors: Luerssen
authors: Marion L
authors: ML
authors: Walker
authors: John R W
authors: JR
authors: Kestle
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications* / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome