title: Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with posthemorrhagic hydrocephalus.
abstract: OBJECTIVE
  Premature, low-birth-weight infants with posthemorrhagic hydrocephalus have a high risk of shunt obstruction and infection. Established risk factors for shunt failure include grade of the hemorrhage and age at shunt insertion. There is anecdotal evidence that the amount of red blood cells or protein levels in the CSF may affect shunt performance. However, this has not been analyzed specifically for this cohort of high-risk patients. Therefore, the authors performed this study to examine whether any statistical relationship exists between the CSF constituents and the rate of shunt malfunction or infection in this population.
  
  
  METHODS
  A retrospective cohort study was performed on premature infants born at Riley Hospital for Children from 2000 to 2009. Inclusion criteria were a CSF sample analyzed within 2 weeks prior to shunt insertion, low birth weight (< 1500 grams), prematurity (birth prior to 37 weeks estimated gestational age), and shunt insertion for posthemorrhagic hydrocephalus. Data points included the gestational age at birth and shunt insertion, weight at birth and shunt insertion, history of CNS infection prior to shunt insertion, shunt failure, shunt infection, and the levels of red blood cells, white blood cells, protein, and glucose in the CSF. Statistical analysis was performed to determine any association between shunt outcome and the CSF parameters.
  
  
  RESULTS
  Fifty-eight patients met the study entry criteria. Ten patients (17.2%) had primary shunt failure within 3 months of insertion. Nine patients (15.5%) had shunt infection within 3 months. A previous CNS infection prior to shunt insertion was a statistical risk factor for shunt failure (p = 0.0290) but not for shunt infection. There was no statistical relationship between shunt malfunction or infection and the CSF levels of red blood cells, white blood cells, protein, or glucose before shunt insertion.
  
  
  CONCLUSIONS
  Low-birth-weight premature infants with posthemorrhagic hydrocephalus have a high rate of shunt failure and infection. The authors did not find any association of shunt failure or infection with CSF cell count, protein level, or glucose level. Therefore, it may not be useful to base the timing of shunt insertion on CSF parameters.
authors.affiliation: Department of Neurosurgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana 46202, USA. d_fulkers@hotmail.com
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Fulkerson
authors.forename: Shobhan
authors.initials: S
authors.lastname: Vachhrajani
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Bohnstedt
authors.forename: Neal B
authors.initials: NB
authors.lastname: Patel
authors.forename: Akash J
authors.initials: AJ
authors.lastname: Patel
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Fox
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
authors.forename: Joel C
authors.initials: JC
authors.lastname: Boaz
mesh_terms: D002555:Cerebrospinal Fluid / Q000166:cytology; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D002557:Cerebrospinal Fluid Shunts; D015331:Cohort Studies; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid* / Q000601:surgery*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000134:cerebrospinal fluid* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D002556:Cerebrospinal Fluid Proteins; D005947:Glucose