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Time trends and age-related etiologies of pediatric hydrocephalus: results of a groupwise analysis in a clinical cohort

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Abstract

Objective

The current study aimed at evaluating experience with pediatric hydrocephalus and reviewing time trends and age-related differences in etiology, management, and outcomes of pediatric hydrocephalus at a tertiary care center in a south Asian country.

Methods

We conducted a retrospective cohort study based on case note review of pediatric patients (age, 1 month to 15 years) with hydrocephalus managed at Aga Khan University Hospital Karachi, over an 18-year period (1988–2005). For analysis, the study period was divided into two epochs (period A, 1988–1996; period B, 1997–2005) and study population was divided into two age groups (0–12 months and 1–15 years).

Results

A total of 338 cases of pediatric hydrocephalus were identified. Most common etiology of pediatric hydrocephalus was meningitis (38.1%), followed by congenital hydrocephalus (20.4%) and brain tumors (8.3%). Shunt infection and blockage were seen in 38 (11.2%) and 54 (16.0%) children, respectively; 67 (19.8%) required shunt revision. Highest rates of shunt failure were seen in bacterial meningitis (35.3%) and aqueductal stenosis (29.2%). Neurological and/or cognitive deficits were observed more frequently in children under 1 year of age (P = 0.029). Duration of hospital stay in period A was significantly higher than in period B (P < 0.001). Mortality occurred in 38 (11.2%); it did not differ between two epochs and age groups (P = 0.059 and P = 0.865, respectively). Highest mortality was associated with intraventricular hemorrhage (23.1%) and brain tumors (21.4%).

Conclusion

Despite recent advancements, hydrocephalus is still associated with high rate of shunt failure and mortality. Factors associated with poor outcome include younger age group and etiology of hydrocephalus.

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Authors and Affiliations

  1. Faculty of Health Sciences, Aga Khan University Medical College, Karachi, Pakistan

    Qura-Tul-Ain Rashid

  2. Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Road, P.O. BOX 3500, Karachi, 74800, Pakistan

    Muhammad Sohail Salat, Kishwar Enam & Saleem Perwaiz Iqbal

  3. Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

    Syed Faraz Kazim, Saniya Siraj Godil & Syed Ather Enam

  4. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

    Syed Iqbal Azam

Authors
  1. Qura-Tul-Ain Rashid
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  2. Muhammad Sohail Salat
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  3. Kishwar Enam
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Correspondence to Kishwar Enam.

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Rashid, QTA., Salat, M.S., Enam, K. et al. Time trends and age-related etiologies of pediatric hydrocephalus: results of a groupwise analysis in a clinical cohort. Childs Nerv Syst 28, 221–227 (2012). https://doi.org/10.1007/s00381-011-1527-5

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  • DOI: https://doi.org/10.1007/s00381-011-1527-5

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