Abstract
Purpose
We aim to correlate the frequency of infections after ventriculoperitoneal (VP) shunt placement in neonates with myelomeningocele (MMC) who did not receive prophylactic antibiotics to the timing of VP shunt placement and the frequency of cerebrospinal fluid (CSF) leakage at the MMC wound.
Methods
Fifty-nine newborns with MMC underwent VP shunt insertion in the period 1983–2007. We reviewed retrospectively all records.
Results
After MMC closure, 24 out of 59 newborns had an infection. The relative risk (RR; 95%) of having an infection is significantly higher [RR = 4,69 (1.145397–19.23568; P = .03761817)], and neuroinfection showed a tendency towards RR = 3.5 (.7067445–17.03112; P = .15414095) in newborns without symptomatic hydrocephalus at birth when we had a wait-and-watch policy (late shunt placement) compared with newborns with prompt shunt placement. The RR (95%) of having an infection [RR = 6,8 (3.314154–13.95228; P = 1.235e-07)] and also neuroinfections [RR = 4,76 (2.043019–11.09025; P = .00044478)] was highly significant if the child presented with MMC wound with CSF leakage before VP shunt insertion (Table 3).
Conclusions
Centers with a conservative antibiotic policy should be even more careful to avoid CSF leakage before shunt placement as this gives a highly significant increased risk of both infections in total and neuroinfections, and they should reconsider this conservative policy in newborns with MMC due to the significantly high infection rate.
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References
Shurtleff DB, Duguay S, Duguay G, Moskowitz D, Weinberger E, Roberts T, Loeser J (1997) Epidemiology of tethered cord with meningomyelocele. Eur J Pediatr Surg 7:7–11
Zachau-Christiansen B, Harmsen AA, Kjølbye J, Nordling J, Philip J, Pedersen BN (1988) Myelomeningocele i Danmark. Ugeskr Laeg 150:480–484 (English summary)
Rintoul NE, Sutton LN, Hubbard AM, Cohen B, Melchionni J, Pasquariello PS, Adzick NS (2002) A new look at myelomeningocele: functional level, vertebral level, shunting, and the implications for fetal intervention. Pediatr 109:409–413
McLone DG, Dias MS (1991) Complications of myelomeningocele closure. Pediatr Neurosurg 17:267–273
Wagner W, Schwarz M, Perneczky A (2002) Primary myelomeningocele closure and consequences. Curr Opin Urol 12:465–468
Parent AD, McMillan T (1995) Contemporaneous shunting with repair of myelomeningocele. Pediatr Neurosurg 11:132–136
Tulipan N, Sutton LN, Bruner JP, Cohen BM, Johnson M, Adzick NS (2003) The effect of myelomeningocele repair on the incidence of shunt-dependent hydrocephalus. Pediatr Neurosurg 38:27–33
Partington MD (2001) Congenital hydrocefalus. Neurosurg Clin N Am 36:737–741
Lie HR, Lie V, Pedersen KT (2003) Boern med rygmarvsbrok, Funktion, trivsel og familiens situation—opfølgning af nordisk studie af 527 boern med myelomeningocele. Solbakkens Raadgivningscenter for bevaegelseshandicap og Rygmarvsbrokforeningen af 1988, Aarhus
Lie HR (1995) Psychosocial development of children with physical disabilities. Experiences from a Nordic study of 527 children with myelomeningocele. Ugeskr Laeger 157:3175–3178
Selber P, Dias L (1998) Sacral level myelomeningocele: longterm outcome. Adults J Pediatr Orthop 18:423–427
Bowman R, McLone DG, Grant JA, Tomita T, Ito JA (2001) Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg 34:114–120
Hunt GM, Alison P (1995) Open spina bifida: a complete cohort reviewed 25 years after closure. Dev Med Child Neurol 37:19–29
Hunt GM (1999) Non-selective intervention in newborn babies with open spina bifida: the outcome 30 years on for the complete cohort. Eur J Pediatr Surg 9:5–8
Caldarelli M, Rocco CD, Marca FL (1996) Shunt complications in the first postoperative year in children with myelomeningocele. Childs Nerv Syst 12:748–754
Tuli S, Drake J, Lamberti-Pasculli M (2003) Long-term outcome of hydrocefalus management in myelomeningocele. Childs Nerv Syst 19:286–291
Vinchon M, Dhellemmes P (2006) Cerebrospinal fluid shunt infection: risk factors and long term follow-up. Childs Nerv Syst 22:692–697
Ratilal B, Costa J, Sampaio C (2008) Antibiotic profylaxis for surgical introduction of intracranial ventricular shunts: a systematic review. J Neurosurg Pediatr 1:48–56
Sacar S, Turgut H, Toprak S, Cirak B, Coskun E, Yilmaz O, Tekin K (2006) A retrospective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period. BMC Infect Dis 6:43
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Thanks to professor Per Bjerre, Department of Neurosurgery, Aarhus University Hospital for his inspiration and help with this project.
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Clemmensen, D., Rasmussen, M.M. & Mosdal, C. A retrospective study of infections after primary VP shunt placement in the newborn with myelomeningocele without prophylactic antibiotics. Childs Nerv Syst 26, 1517–1521 (2010). https://doi.org/10.1007/s00381-010-1113-2
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DOI: https://doi.org/10.1007/s00381-010-1113-2