923 Utilization of a Gestational Age Threshold May Improve Pediatric VP Shunt Outcomes

Abstract

INTRODUCTION: The highest shunt failure rates occur in patients with hydrocephalus from intraventricular hemorrhage of prematurity (Premie-IVH). Tuli et al (1999) described a 40-week gestational age threshold that significantly differentiated shunt failure rates in a neonatal hydrocephalus population, but this threshold has not been investigated in a dedicated Premie-IVH cohort. METHODS: A retrospective cohort study was performed on patients treated for hydrocephalus with VP shunt implant at an academic pediatric institution from 2010-2021. Inclusion criteria were hydrocephalus from Premie-IVH, known gestational age at delivery, 1 year of follow-up, and known surgical history prior to VP shunt implant. RESULTS: Among 32 Premie-IVH patients, 50% experienced shunt failure within 1 year after VP shunt implant. Average gestational age (GA) at delivery was 27.5 weeks and average GA at surgery was 45.2 weeks. In total, 44% of patients received a VP shunt before 40 weeks of gestational age. In this population, 64% experienced VP shunt failure within one year and had an average of 0.79 temporizing surgeries prior to VP shunt implant. In the 56% of patients who received VP shunt surgery after 40 weeks of GA, 39% experienced VP shunt failure within one year and had an average of 1.3 temporizing surgeries prior to VP shunt surgery. CONCLUSIONS: In patients with hydrocephalus from Premie-IVH, those who had VP shunt surgery after 40 weeks gestational age received a greater number of temporizing measures while experiencing a 49% lower VP shunt failure rate. Temporizing measures may be used to improve VP shunt outcomes by delaying VP shunt surgery until after 40 weeks gestational age.