{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,18]],"date-time":"2025-05-18T18:41:10Z","timestamp":1747593670084,"version":"3.37.3"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T00:00:00Z","timestamp":1699315200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T00:00:00Z","timestamp":1699315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Childs Nerv Syst"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Extremely premature neonates diagnosed with post-haemorrhagic hydrocephalus (PHH) are recognised to have particularly poor outcomes. This study assessed the impact of a number of variables on outcomes in this cohort, in particular the choice of shunt valve mechanism.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Electronic case notes were retrospectively reviewed of all premature neonates admitted to our centre for management of hydrocephalus between 2012 and 2021. Data included (i) gestational age, (ii) birth weight, (iii) hydrocephalus aetiology, (iv) surgical intervention, (v) shunt system, (vi) \u2018surgical burden\u2019 and (vii) wound failure and infection rate. Data was handled in Microsoft Excel and statistical analysis performed in SPSS v27.0<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p><jats:italic>N<\/jats:italic>\u2009=\u200953 premature hydrocephalic patients were identified (<jats:italic>n<\/jats:italic>\u2009=\u200928 (52.8%) female). Median gestational age at birth was 27\u00a0weeks (range: 23\u201336\u2009+\u20096\u00a0weeks), with <jats:italic>n<\/jats:italic>\u2009=\u200935 extremely preterm patients and median birth weight of 1.9\u00a0kg (range: 0.8\u20133.6\u00a0kg). Total <jats:italic>n<\/jats:italic>\u2009=\u200999 programmable valves were implanted (<jats:italic>n<\/jats:italic>\u2009=\u200928 (28.3%) de novo, <jats:italic>n<\/jats:italic>\u2009=\u200971 (71.2%) revisions); <jats:italic>n<\/jats:italic>\u2009=\u200928 (28.3%) underwent <jats:italic>n<\/jats:italic>\u2009\u2265\u20091 pressure alterations, after which <jats:italic>n<\/jats:italic>\u2009=\u200921 (75%) patients had symptoms improve. In <jats:italic>n<\/jats:italic>\u2009=\u20098 patients exchanged from fixed to programmable valves, a mean reduction of 1.9 revisions per patient after exchange was observed (95%CI: 0.36\u20133.39, <jats:italic>p<\/jats:italic>\u2009=\u20090.02). Mean overall shunt survival was 39.5\u00a0weeks (95%CI: 30.6\u201348.5); 33.2\u00a0weeks (95%CI: 25.2\u201341.1) in programmable valves and 35.1\u00a0weeks (95%CI: 19.5\u201350.6) in fixed pressure (<jats:italic>p<\/jats:italic>\u2009=\u20090.22) with 12-month survival rates of 25.7% and 24.7%, respectively (<jats:italic>p<\/jats:italic>\u2009=\u20090.22). Shorter de novo shunt survival was associated with higher operation count overall (Pearson\u2019s <jats:italic>R<\/jats:italic>:\u2009\u2212\u20090.54, 95%CI:\u2009\u2212\u20090.72 to\u2009\u2212\u20090.29, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Wound failure, gestational age and birth weight were significantly associated with shorter de novo shunt survival in a Cox regression proportional hazards model; gestational age had the greatest impact on shunt survival (Exp(B): 0.71, 95%CI: 0.63\u20130.81, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Hydrocephalus is especially challenging in extreme prematurity, with a shorter de novo shunt survival associated with higher number of future revisions. Programmable valves provide flexibility with regard to pressure setting, with the potential for fewer shunt revisions in this complex cohort.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00381-023-06204-8","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T09:02:58Z","timestamp":1699347778000},"page":"1091-1098","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Hydrocephalus in prematurity: does valve choice make a difference?"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9529-5072","authenticated-orcid":false,"given":"Benjamin J.","family":"Hall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad M.S.","family":"Ali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn","family":"Hennigan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedetta","family":"Pettorini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,11,7]]},"reference":[{"key":"6204_CR1","doi-asserted-by":"crossref","unstructured":"Alotaibi WS (2020) Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk factors, and hospital policy. Childs Nerv Syst 36(12):2971\u20139","DOI":"10.1007\/s00381-020-04621-7"},{"issue":"4","key":"6204_CR2","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.clp.2008.07.010","volume":"35","author":"AJ Du Plessis","year":"2008","unstructured":"Du Plessis AJ (2008) Cerebrovascular injury in premature infants: current understanding and challenges for future prevention. Clin Perinatol 35(4):609\u2013641","journal-title":"Clin Perinatol"},{"issue":"9","key":"6204_CR3","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1177\/0883073809339361","volume":"24","author":"AJ Du Plessis","year":"2009","unstructured":"Du Plessis AJ (2009) The role of systemic hemodynamic disturbances in prematurity-related brain injury. J Child Neurol 24(9):1127\u20131140","journal-title":"J Child Neurol"},{"key":"6204_CR4","doi-asserted-by":"crossref","unstructured":"Bruce RB, Carole AB, Allen TM, Yvonne EV, Hector EJ, Raul FB (1986) Ventriculoperitoneal shunts in low birth weight infants with intracranial hemorrhage: neurodevelopmental outcome. Neurosurgery 18(2):141\u20135","DOI":"10.1227\/00006123-198602000-00004"},{"issue":"6","key":"6204_CR5","first-page":"186","volume":"10","author":"B Pettorini","year":"2014","unstructured":"Pettorini B, Keh R, Ellenbogen J, Williams D, Zebian\u00a0B (2014) Intraventricular haemorrhage in prematurity. Infant 10(6):186\u2013190","journal-title":"Intraventricular haemorrhage in prematurity Infant"},{"key":"6204_CR6","doi-asserted-by":"crossref","unstructured":"Adams-Chapman I, Hansen NI, Stoll BJ, Higgins R (2008) for the NICHD Research Network. Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion. Pediatrics 121(5):e1167\u201377","DOI":"10.1542\/peds.2007-0423"},{"issue":"5","key":"6204_CR7","first-page":"983","volume":"40","author":"HJ Pikus","year":"1997","unstructured":"Pikus HJ, Levy ML, Gans W, Mendel E, McComb JG (1997) Outcome, cost analysis, and long-term follow-up in preterm infants with massive grade IV germinal matrix hemorrhage and progressive hydrocephalus: neurosurgery 40(5):983\u2013989","journal-title":"Outcome, cost analysis, and long-term follow-up in preterm infants with massive grade IV germinal matrix hemorrhage and progressive hydrocephalus: neurosurgery"},{"issue":"6","key":"6204_CR8","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1227\/00006123-198106000-00001","volume":"8","author":"V Albanese","year":"1981","unstructured":"Albanese V, Tomasello F, Sampaolo S (1981) Multiloculated hydrocephalus in infants. Neurosurgery 8(6):641\u2013646","journal-title":"Neurosurgery"},{"issue":"3","key":"6204_CR9","doi-asserted-by":"publisher","first-page":"357","DOI":"10.3171\/jns.1985.62.3.0357","volume":"62","author":"TW Eller","year":"1985","unstructured":"Eller TW, Pasternak JF (1985) Isolated ventricles following intraventricular hemorrhage. J Neurosurg 62(3):357\u2013362","journal-title":"J Neurosurg"},{"issue":"11","key":"6204_CR10","doi-asserted-by":"publisher","first-page":"3485","DOI":"10.1007\/s00381-021-05326-1","volume":"37","author":"BJ Hall","year":"2021","unstructured":"Hall BJ, Gillespie CS, Sunderland GJ, Conroy EJ, Hennigan D, Jenkinson MD et al (2021) Infant hydrocephalus: what valve first? Childs Nerv Syst 37(11):3485\u20133495","journal-title":"Childs Nerv Syst"},{"issue":"13","key":"6204_CR11","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.853417","volume":"21","author":"Y Wang","year":"2022","unstructured":"Wang Y, Song J, Zhang X, Kang W, Li W, Yue Y et al (2022) The impact of different degrees of intraventricular hemorrhage on mortality and neurological outcomes in very preterm infants: a prospective cohort study. Front Neurol 21(13):853417","journal-title":"Front Neurol"},{"issue":"5","key":"6204_CR12","first-page":"471","volume":"11","author":"LE Eichenfield","year":"1999","unstructured":"Eichenfield LE, Hardaway CA (1999) Neonatal dermatology: current opinion in pediatrics 11(5):471\u2013474","journal-title":"Neonatal dermatology: current opinion in pediatrics"},{"key":"6204_CR13","doi-asserted-by":"crossref","unstructured":"IIHS Investigators, Kulkarni AV, Sgouros S, Constantini S (2016) International infant hydrocephalus study: initial results of a prospective, multicenter comparison of endoscopic third ventriculostomy (ETV) and shunt for infant hydrocephalus. Childs Nerv Syst 32(6):1039\u201348","DOI":"10.1007\/s00381-016-3095-1"},{"issue":"8","key":"6204_CR14","doi-asserted-by":"publisher","first-page":"2115","DOI":"10.1007\/s00381-023-05935-y","volume":"39","author":"Y Wu","year":"2023","unstructured":"Wu Y, Liang P, Li L, Zhou Y, Wang D, Zhai X (2023) Neurodevelopmental outcomes of neonatal posthemorrhagic hydrocephalus and psychological effects on the parents. Childs Nerv Syst 39(8):2115\u20132122","journal-title":"Childs Nerv Syst"}],"container-title":["Child's Nervous System"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-023-06204-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00381-023-06204-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-023-06204-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T08:08:38Z","timestamp":1711526918000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00381-023-06204-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,7]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["6204"],"URL":"https:\/\/doi.org\/10.1007\/s00381-023-06204-8","relation":{},"ISSN":["0256-7040","1433-0350"],"issn-type":[{"type":"print","value":"0256-7040"},{"type":"electronic","value":"1433-0350"}],"subject":[],"published":{"date-parts":[[2023,11,7]]},"assertion":[{"value":"22 September 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 October 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 November 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Audit approval was obtained from the Alder Hey Neurosurgical Department clinical team prior to commencement of the study. Ethical approval for this study was not required in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"All data collected and used in the study was fully anonymised prior to analysis and submission for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All data collected and used in the study was fully anonymised prior to analysis and submission for publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no relevant financial or non-financial interests to disclose","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}