title: Time trends and age-related etiologies of pediatric hydrocephalus: results of a groupwise analysis in a clinical cohort.
abstract: OBJECTIVE
  The current study aimed at evaluating experience with pediatric hydrocephalus and reviewing time trends and age-related differences in etiology, management, and outcomes of pediatric hydrocephalus at a tertiary care center in a south Asian country.
  
  
  METHODS
  We conducted a retrospective cohort study based on case note review of pediatric patients (age, 1 month to 15 years) with hydrocephalus managed at Aga Khan University Hospital Karachi, over an 18-year period (1988-2005). For analysis, the study period was divided into two epochs (period A, 1988-1996; period B, 1997-2005) and study population was divided into two age groups (0-12 months and 1-15 years).
  
  
  RESULTS
  A total of 338 cases of pediatric hydrocephalus were identified. Most common etiology of pediatric hydrocephalus was meningitis (38.1%), followed by congenital hydrocephalus (20.4%) and brain tumors (8.3%). Shunt infection and blockage were seen in 38 (11.2%) and 54 (16.0%) children, respectively; 67 (19.8%) required shunt revision. Highest rates of shunt failure were seen in bacterial meningitis (35.3%) and aqueductal stenosis (29.2%). Neurological and/or cognitive deficits were observed more frequently in children under 1 year of age (P = 0.029). Duration of hospital stay in period A was significantly higher than in period B (P < 0.001). Mortality occurred in 38 (11.2%); it did not differ between two epochs and age groups (P = 0.059 and P = 0.865, respectively). Highest mortality was associated with intraventricular hemorrhage (23.1%) and brain tumors (21.4%).
  
  
  CONCLUSIONS
  Despite recent advancements, hydrocephalus is still associated with high rate of shunt failure and mortality. Factors associated with poor outcome include younger age group and etiology of hydrocephalus.
authors.affiliation: Faculty of Health Sciences, Aga Khan University Medical College, Karachi, Pakistan.
authors.forename: Qura-Tul-Ain
authors.initials: QT
authors.lastname: Rashid
authors.forename: Muhammad Sohail
authors.initials: MS
authors.lastname: Salat
authors.forename: Kishwar
authors.initials: K
authors.lastname: Enam
authors.forename: Syed Faraz
authors.initials: SF
authors.lastname: Kazim
authors.forename: Saniya Siraj
authors.initials: SS
authors.lastname: Godil
authors.forename: Syed Ather
authors.initials: SA
authors.lastname: Enam
authors.forename: Saleem Perwaiz
authors.initials: SP
authors.lastname: Iqbal
authors.forename: Syed Iqbal
authors.initials: SI
authors.lastname: Azam
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001927:Brain Diseases / Q000150:complications; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications