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Spondyloptosis is defined as greater than 100% subluxation of one vertebra over another; it most commonly develops due to dysplastic spondyloslisthesis but can also develop as a result of traumatic fracture-dislocations. In the past, given the significant force associated with this injury, most patients did not survive the initial trauma and resusc...
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Context 1
... fixed deformity was felt to be related to partial fusion and post-traumatic fibrosis from the delay in treatment. The decision was made then to close anteriorly and proceed with posterior release with reduction and correction of his deformity with L2-pelvis fusion posteriorly ( Figure 2). ...
Citations
Objective It has been speculated whether the insertion of a temporary device to control hydrocephalus secondary to intra-ventricular hemorrhage (IVH) in the preterm neonate with removal of the debris caused by such a hemorrhage, can reduce subsequent complications following insertion of a permanent cerebrospinal fluid (CSF) diverting shunt. This retrospective review is directed at examining this speculation. Methods A retrospective review of the medical records of all premature infants surgically treated for post-hemorrhagic hydrocephalus (PHH) between 1997 and 2012 at our institution was undertaken. Results Over 14 years, 91 preterm infants with PHH were identified. The initial procedure for 50 neonates was the insertion of a ventricular reservoir (VR) that was serially tapped for varying time periods. For the remaining 41 premature infants, a ventriculoperitoneal/atrial shunt (VS) was the first procedure. Patients with a VR as their initial procedure underwent CSF diversion significantly earlier in life than those who had VS as the initial procedure (29 vs. 56 days, p < 0.01). Of the infants with a VR as their initial procedure, 5/50 (10%) did not undergo a subsequent VS. The number of shunt revisions and the rates of loculated hydrocephalus and shunt infection did not statistically differ between the two groups. Conclusion Patients with initial VR insertion received a CSF diversion procedure at a significantly younger age than those who received a permanent shunt as their initial procedure. Otherwise, the outcomes with regards to shunt revisions, loculated hydrocephalus, and shunt infection were not different for the two groups.
OBJECT
Even with improved prenatal and neonatal care, intraventricular hemorrhage (IVH) occurs in approximately 25%–30% of preterm infants, with a subset of these patients developing hydrocephalus. This study was undertaken to describe current trends in hospitalization of preterm infants with posthemorrhagic hydrocephalus (PHH) using the Nationwide Inpatient Sample (NIS) and the Kids’ Inpatient Database (KID).
METHODS
The KID and NIS were combined to generate data for the years 2000–2010. All neonatal discharges with ICD-9-CM codes for preterm birth with IVH alone or with IVH and hydrocephalus were included.
RESULTS
There were 147,823 preterm neonates with IVH, and 9% of this group developed hydrocephalus during the same admission. Of patients with Grade 3 and 4 IVH, 25% and 28%, respectively, developed hydrocephalus in comparison with 1% and 4% of patients with Grade 1 and 2 IVH, respectively. Thirty-eight percent of patients with PHH had permanent ventricular shunts inserted. Mortality rates were 4%, 10%, 18%, and 40%, respectively, for Grade 1, 2, 3, and 4 IVH during initial hospitalization. Length of stay has been trending upward for both groups of IVH (49 days in 2000, 56 days in 2010) and PHH (59 days in 2000, 70 days in 2010). The average hospital cost per patient (adjusted for inflation) has also increased, from $201,578 to $353,554 (for IVH) and $260,077 to $495,697 (for PHH) over 11 years.
CONCLUSIONS
The number of neonates admitted with IVH has increased despite a decrease in the number of preterm births. Rates of hydrocephalus and mortality correlated closely with IVH grade. The incidence of hydrocephalus in preterm infants with IVH remained stable between 8% and 10%. Over an 11-year period, there was a progressive increase in hospital cost and length of stay for preterm neonates with IVH and PHH that may be explained by a concurrent increase in the proportion of patients with congenital cardiac anomalies.
