Child's Nervous System

, Volume 34, Issue 5, pp 829–835 | Cite as

Early elective delivery for fetal ventriculomegaly: are neurosurgical and medical complications mitigated by this practice?

  • Clinton D. Morgan
  • Travis R. Ladner
  • George L. Yang
  • Marjorie N. Moore
  • Russell D. Parks
  • William F. Walsh
  • John C. Wellons
  • Chevis N. Shannon
Original Paper

Abstract

Purpose

Antenatally diagnosed ventriculomegaly (VM) requires the balance of risks of neurological injury with premature delivery. The purpose of this study was to evaluate outcomes related to early elective delivery due to fetal VM at our institution.

Methods

We retrospectively assessed 120 babies (2008–2012) with antenatally diagnosed fetal VM. Inclusion criteria for (“early”) cohort were (1) elective delivery occurred for expedited neurosurgical intervention between 32 and 36 weeks EGA and (2) fetal VM noted on official antenatal ultrasound. The comparative “near term” cohort differed only in that delivery occurred at 37+ weeks EGA. Statistical significance for comparative analyses set a priori at p < 0.05.

Results

Babies electively delivered early had a lower birthweight (p < 0.0001), greater ventricle width (p < 0.0001), and underwent initial CSF diversion sooner (p = 0.014). The early cohort (n = 22), compared to near term (n = 50), had a lower birthweight (p < 0.0001), greater ventricle width (p < 0.0001), and underwent initial CSF diversion sooner (p = 0.014). The early cohort required more repeat procedures: (45 vs. 22% p = 0.021), and VPS removals after VPS infections (41 vs. 12%, p = 0.010). Additionally, newborn respiratory failure (32 vs. 6%, p = 0.037) was more common. Finally, of four babies who died in the early cohort, 2/4 died for prematurity-associated pulmonary hypoplasia.

Conclusions

While early elective delivery for fetal VM expedites intervention for rapidly expanding ventricles, few benefits were identified. Our study concluded those infants that were delivered earlier had increased VPS infections, repeat neurosurgical procedures, and medical co-morbidities. A multi-institutional prospective observational study would be needed in order to confirm the clinical implications of such practice.

Keywords

Hydrocephalus Pre-natal diagnosis Ventriculoperitoneal shunt 

Notes

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Clinton D. Morgan
    • 1
    • 2
    • 3
  • Travis R. Ladner
    • 1
    • 3
  • George L. Yang
    • 1
    • 3
  • Marjorie N. Moore
    • 1
  • Russell D. Parks
    • 1
    • 3
  • William F. Walsh
    • 4
  • John C. Wellons
    • 1
    • 3
  • Chevis N. Shannon
    • 1
    • 3
  1. 1.Department of Neurological Surgery, Monroe Carell Jr Children’s Hospital at VanderbiltVanderbilt University School of MedicineNashvilleUSA
  2. 2.Department of Neurological SurgeryBarrow Neurological InstitutePhoenixUSA
  3. 3.Surgical Outcomes Center for Kids (SOCKs)Vanderbilt University Medical CenterNashvilleUSA
  4. 4.Division of NeonatologyVanderbilt University School of MedicineNashvilleUSA

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