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Posthemorrhagic hydrocephalus management in patients with necrotizing enterocolitis: a monocentric experience

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Abstract

Purpose

Posthemorrhagic hydrocephalus (PHH) and necrotizing enterocolitis (NEC) are two comorbidities associated with prematurity. The management of patients with both conditions is complex and it is necessary to intercept them to avoid meningitis and multilocular hydrocephalus.

Methods

In a single-center retrospective study, we analyzed 19 patients with NEC and PHH admitted from 2012 to 2022. We evaluated perinatal, imaging, and NEC-related data. We documented shunt obstruction and infection and deaths within 12 months of shunt insertion.

Results

We evaluated 19 patients with NEC and PHH. Six cases (31.58%) were male, the median birth weight was 880 g (650–3150), and the median gestational age was 26 weeks (23–38). Transfontanellar ultrasound was performed on 18 patients (94.74%) and Levine classification system was used: 3 cases (15.79%) had a mild Levine index, 11 cases (57.89%) had moderate, and 5 cases (26.32%) were graded as severe. Magnetic resonance showed intraventricular hemorrhage in 14 cases (73.68%) and ventricular dilatation in 15 cases (78.95%). The median age at shunt insertion was 24 days (9–122) and the median length of hospital stay was 120 days (11–316). Sepsis was present in 15 cases (78.95%). NEC-related infection involved the peritoneal shunt in 4 patients and 3 of them had subclinical NEC. At the last follow-up, 6 (31.58%) patients presented with psychomotor delay. No deaths were reported.

Conclusions

Although recognition of subclinical NEC is challenging, the insertion of a ventriculoperitoneal shunt is not recommended in these cases and alternative treatments should be considered to reduce the risk of meningitis and shunt malfunction.

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Authors and Affiliations

  1. Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Martina Monti, Gloria Mandrile & Girolamo Mattioli

  2. DINOGMI, University of Genoa, Genoa, Italy

    Martina Monti, Gloria Mandrile & Girolamo Mattioli

  3. Neurosurgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Gianluca Piatelli & Marco Pavanello

  4. Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Andrea Rossi

  5. Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy

    Andrea Rossi

  6. Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Andrea Moscatelli

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  1. Martina Monti
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Contributions

Martina Monti and Marco Pavanello wrote the main text of the manuscript and Gloria Mandrile prepared the tables and Figs. 1, 2, and 3. All authors made substantial contributions to critical revisions and approval of the final version to be published.

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Correspondence to Martina Monti.

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Monti, M., Mandrile, G., Piatelli, G. et al. Posthemorrhagic hydrocephalus management in patients with necrotizing enterocolitis: a monocentric experience. Childs Nerv Syst 40, 471–478 (2024). https://doi.org/10.1007/s00381-023-06129-2

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  • DOI: https://doi.org/10.1007/s00381-023-06129-2

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