Necrotizing enterocolitis complicating the management of posthemorrhagic hydrocephalus

Abstract

The case notes of all newborn infants with posthemorrhagic hydrocephalus (PHH) operated over the past 10 years at our institution were reviewed to establish the incidence and the effect of necrotizing enterocolitis (NEC) on morbidity and mortality following cerebrospinal fluid (CSF) shunting. Thirteen neonates had both PHH and NEC (group A); 7 of these patients were initially treated by ventriculoatrial (VA) shunt and six by ventriculoperitoneal (VP) shunt. Seventyfive patients had PHH alone (group B); all were treated by VP shunt. Eight patients in group A required an abdominal operation for NEC. The two groups were comparable for birth weight, gestational age, and other complications of prematurity. Episodes of shunt malfunction (infection and/or obstruction) and deaths occurring within 12 months from shunt insertion, in the two groups were compared. Shunt malfunction was more frequent in group A (72%) than in group B (27%) ( P < .001). Shunt infection was observed in 39% of group A patients versus 14% in group B ( P = .03). Distal shunt obstructions occurred in 28% of group A patients and only 3% of group B patients ( P = .001). There were more deaths in group A (62% v 9%; P < .001). Thirty-one percent of group A patients and 4% of group B patients died following shunt complications ( P = .006). In group A, there was no significant difference in mortality and shunt malfunction between patients with VA or VP shunts. The method of treatment and the stage of NEC did not influence morbidity and mortality after internal drainage for PHH. Internal shunting seems not to be the optimal treatment for PHH in newborn infants with NEC. Alternative forms of therapy, such as long-term external ventricular drainage or choroid plexus coagulation, should be considered in these patients.