Clinton D Morgan1,2,3, Travis R Ladner1,3, George L Yang1,3, Marjorie N Moore1, Russell D Parks1,3, William F Walsh4, John C Wellons1,3, Chevis N Shannon5,6. 1. Department of Neurological Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, 2200 Children's Way, 9226 Doctors' Office Tower (DOT), Nashville, TN, 37232-9557, USA. 2. Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ, USA. 3. Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA. 4. Division of Neonatology, Vanderbilt University School of Medicine, Nashville, TN, USA. 5. Department of Neurological Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, 2200 Children's Way, 9226 Doctors' Office Tower (DOT), Nashville, TN, 37232-9557, USA. Chevis.n.shannon@vanderbilt.edu. 6. Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA. Chevis.n.shannon@vanderbilt.edu.
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.
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.
Authors: N Bruinsma; E E Stobberingh; M J Herpers; J S Vles; B J Weber; D A Gavilanes Journal: Clin Microbiol Infect Date: 2000-04 Impact factor: 8.067
Authors: Helen Carnaghan; Susana Pereira; Catherine P James; Paul B Charlesworth; Marco Ghionzoli; Elkhouli Mohamed; Kate M K Cross; Edward Kiely; Shailesh Patel; Ashish Desai; Kypros Nicolaides; Joseph I Curry; Niyi Ade-Ajayi; Paolo De Coppi; Mark Davenport; Anna L David; Agostino Pierro; Simon Eaton Journal: J Pediatr Surg Date: 2014-06 Impact factor: 2.545