{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:59:35Z","timestamp":1790391575034,"version":"4.1.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,17]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Intrathecal baclofen (ITB) pumps (ITBPs) are commonly used to provide symptomatic relief and facilitate patient care for children with spasticity. Unfortunately, patients are at long-term risk for device-related infections. Removal of infected pumps can require complicated, prolonged hospital stays for systematic reduction of preexisting high doses of ITB. The management strategy for ITBP infections has not been clearly defined. In this study, the authors sought to determine whether immediate reimplantation after wound washout is a viable strategy when managing ITBP infections rather than the more standard-of-care approach of removal and delayed reimplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective review was performed for patients who underwent ITBP placement at Children\u2019s National Hospital from 1999 to 2023 (24 years) with subsequent infection requiring removal and reimplantation. Demographics, timing of reimplantation, and outcomes were collected. Statistical analysis was performed with unpaired t-tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Over 24 years, 356 baclofen pump implantation surgeries were performed with an overall infection rate of 9.8%. Seven patients underwent ITBP removal and delayed reimplantation, and 16 underwent washout with immediate reimplantation followed by extended intravenous antibiotic therapy. There was a statistically significant decrease\/wean in ITB dose prior to surgery in the delayed group compared with the immediate reimplantation group (dose decreased by a mean of 209.1 vs 15.6 \u03bcg\/day, p = 0.01) with a resultant increase in preoperative length of stay for baclofen weaning (2.57 vs 1.19 days), overall hospital stay (mean 13.14 vs 7.63 days), and postoperative baclofen withdrawal (42.9% vs 6.3%, p = 0.03). There was a significantly increased risk of reinfection in the immediate reimplantation cohort (63% vs 14%, p = 0.03). However, 33% of the patients with successful immediate reimplantation were able to maintain their current baclofen dose and did not require a prolonged ICU stay. Eighty percent of patients who experienced reinfection after immediate reimplantation chose final removal, while 86% of patients who underwent delayed reimplantation still have an existing ITBP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>There is a lower risk of reinfection with removal and delayed reimplantation of ITBPs, and more patients in this cohort ultimately maintained their device. However, for patients on high ITB doses, immediate reimplantation in select cases may help to shorten hospital stays and prevent dangerous baclofen withdrawals and is successful for long-term pump utilization (without infection) one-third of the time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.2.peds25438","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:31Z","timestamp":1784073631000},"page":"1-7","source":"Crossref","is-referenced-by-count":0,"title":["Intrathecal baclofen pump infection management: immediate versus delayed reimplantation. A single-center, 24-year experience"],"prefix":"10.3171","author":[{"given":"Joseph H.","family":"McAbee","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Hospital, Washington, DC"},{"name":"Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick F.","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Hospital, Washington, DC"},{"name":"Neurosurgical Associates, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saige","family":"Teti","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Hospital, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh N.","family":"Magge","sequence":"additional","affiliation":[{"name":"C. S. Mott Children\u2019s Hospital, University of Michigan Health, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chima O.","family":"Oluigbo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Hospital, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Keating","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Hospital, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Arch Phys Med Rehabil","first-page":"1721","article-title":"Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications","volume":"83","author":"Murphy NA","year":"2002","unstructured":"Murphy NA, Irwin MCN, Hoff C. Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications. Arch Phys Med Rehabil. 2002;83(12):1721\u20131725. doi:10.1053\/apmr.2002.36068"},{"issue":"1","key":"b2","series-title":"J Spinal Cord Med","first-page":"2","article-title":"Managing spasticity in spinal cord injury: safe administration of bridge boluses during intrathecal baclofen pump refills","volume":"26","author":"Elovic E","year":"2003","unstructured":"Elovic E, Kirshblum SC. Managing spasticity in spinal cord injury: safe administration of bridge boluses during intrathecal baclofen pump refills. J Spinal Cord Med. 2003;26(1):2\u20134. doi:10.1080\/10790268.2003.11753652"},{"issue":"4","key":"b3","series-title":"Pediatr Emerg Care","first-page":"271","article-title":"Baclofen pumps: uses and complications","volume":"33","author":"Woolf SM","year":"2017","unstructured":"Woolf SM, Baum CR. Baclofen pumps: uses and complications. Pediatr Emerg Care. 2017;33(4):271\u2013275. doi:10.1097\/PEC.0000000000001090"},{"issue":"2","key":"b4","series-title":"Spinal Cord","first-page":"107","article-title":"Management of acute overdose or withdrawal state in intrathecal baclofen therapy","volume":"50","author":"Watve SV","year":"2012","unstructured":"Watve SV, Sivan M, Raza WA, Jamil FF. Management of acute overdose or withdrawal state in intrathecal baclofen therapy. Spinal Cord. 2012;50(2):107\u2013111. doi:10.1038\/sc.2011.112"},{"issue":"6","key":"b5","series-title":"Neuromodulation","first-page":"632","article-title":"Best practices for intrathecal baclofen therapy: troubleshooting","volume":"19","author":"Saulino M","year":"2016","unstructured":"Saulino M, Anderson DJ, Doble J,  Best practices for intrathecal baclofen therapy: troubleshooting. Neuromodulation. 2016;19(6):632\u2013641. doi:10.1111\/ner.12467"},{"issue":"2","key":"b6","series-title":"Neurol Clin Pract","first-page":"123","article-title":"Managing loss of intrathecal baclofen efficacy: review of the literature and proposed troubleshooting algorithm","volume":"4","author":"Boster A","year":"2014","unstructured":"Boster A, Nicholas J, Bartoszek MP, O\u2019Connell C, Oluigbo C. Managing loss of intrathecal baclofen efficacy: review of the literature and proposed troubleshooting algorithm. Neurol Clin Pract. 2014;4(2):123\u2013130. doi:10.1212\/cpj.0000000000000000"},{"issue":"1 Suppl","key":"b7","series-title":"J Neurosurg","first-page":"9","article-title":"Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients","volume":"104","author":"Vender JR","year":"2006","unstructured":"Vender JR, Hester S, Waller JL, Rekito A, Lee MR. 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