Neurodevelopmental outcomes after ventriculoperitoneal shunt placement in children with non-infectious hydrocephalus: a meta-analysis

Child's Nervous System (2021)Cite this article

Abstract

Background

Hydrocephalus is diagnosed when an accumulating amount of cerebrospinal fluid (CSF) fails to circulate and/or absorbed in the ventricular system. Based on its etiology, hydrocephalus can be classified into infectious and non-infectious hydrocephalus. In children, non-infectious hydrocephalus includes congenital hydrocephalus, posthemorrhagic hydrocephalus, neural tube defect–related hydrocephalus, and tumor-related hydrocephalus. Regardless of the cause, a CSF diversion device is placed to divert the excess fluid from the ventricles into peritoneal cavity. Among all, ventriculoperitoneal (VP) shunt is arguably the most commonly used CSF diversion device to date. Until now, the long-term neurodevelopmental impact of VP shunt placement in non-infectious hydrocephalus patients remained unclear.

Objective

This study aims to evaluate the neurodevelopmental outcomes in children with non-infectious hydrocephalus who had VP shunt placement.

Materials and methods

Systematic searches were performed using PubMed, Google Scholar, Scopus databases, and reference lists. Publications that fulfilled the inclusion criteria were included in the meta-analysis. Calculation of Mantel-Haezel risk ratio (RR) was applied, and heterogeneity index (I2) test was used to evaluate the existence of heterogeneity in all studies. Risk of bias was assessed based on the criteria from the Newcastle-Ottawa Scale (NOS).

Results

Of the 1929 studies identified, 12 publications were concluded to have fulfilled the inclusion criteria. Results from the meta-analysis showed that the risks of cerebral palsy, visual and hearing impairment, epilepsy, or seizures are significantly higher in children with non-infectious hydrocephalus who already had VP shunt placement (shunted non-infectious hydrocephalus, S-NIH) compared to that of the healthy control. The meta-analysis on intelligent quotient (IQ) and mental development index (MDI) showed that S-NIH children tend to score lower IQ and acquire risk of having mental development delay. On motoric development, S-NIH children scored lower motoric score and have significantly higher risk of motor development delay compared to control. Although normal children tend to have more internalizing behavior compared to S-NIH children, overall assessment on the risk of behavioral abnormalities showed that the differences between these two groups are insignificant.

Conclusion

S-NIH children have significantly higher risks of disabilities and mental and motoric development delays; thus, planning on continuous rehabilitation for children with non-infectious hydrocephalus who already had placement of VP shunt is important to acquire their optimum potentials and quality of life.

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Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

References

  1. 1.

    Rekate HL (2009) A contemporary definition and classification of hydrocephalus. Semin Pediatr Neurol 16(1):9–15. https://doi.org/10.1016/j.spen.2009.01.002

    Article  PubMed  Google Scholar 

  2. 2.

    Dewan MC, Rattani A, Mekary R, Glancz LJ, Yunusa I, Baticulon RE, Fieggen G, Wellons JC, Park KB, Warf BC (2018) Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg 130:1–15. https://doi.org/10.3171/2017.10.JNS17439

    Article  Google Scholar 

  3. 3.

    Kahle KT, Kulkarni AV, Limbrick DD Jr, Warf BC (2016) Hydrocephalus in children. Lancet 387(10020):788–799. https://doi.org/10.1016/S0140-6736(15)60694-8

    Article  PubMed  Google Scholar 

  4. 4.

    Al-Dosari MS, Al-Owain M, Tulbah M et al (2013) Mutation in MPDZ causes severe congenital hydrocephalus. J Med Genet 50(1):54–58. https://doi.org/10.1136/jmedgenet-2012-101294

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Hommet C, Cottier JP, Billard C, Perrier D, Gillet P, De Toffol B et al (2002) MRI morphometric study and correlation with cognitive functions in young adults shunted for congenital hydrocephalus related to spina bifida. Eur Neurol 47(3):169–174. https://doi.org/10.1159/000047977

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Bawa M, Dash V, Mahalik S, Rao KLN (2019) Outcome analysis of patients of congenital hydrocephalus with ventriculoperitoneal shunt at a tertiary care hospital in North India. Pediatr Neurosurg 54(4):233–236. https://doi.org/10.1159/000501018

    Article  PubMed  Google Scholar 

  7. 7.

    Venkataramana NK, Mukundan CR (2011) Evaluation of functional outcomes in congenital hydrocephalus. J Pediatr Neurosci 6(1):4–12. https://doi.org/10.4103/1817-1745.84399

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analysis of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  Google Scholar 

  9. 9.

    Hagberg B, Hagberg G, Beckung E, Uvebrant P (2001) Changing panorama of cerebral palsy in Sweden. VIII. Prevalence and origin in the birth year period 1991–94. Acta Paediatr 90:271–277

    CAS  Article  Google Scholar 

  10. 10.

    Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2013) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp 2014

  11. 11.

    Adams-Chapman I, Hansen NI, Stoll BJ, Higgins R, for the NICHD Research Network (2008) Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion. Pediatrics 121(5):1167–1179. https://doi.org/10.1542/peds.2007-0423

    Article  Google Scholar 

  12. 12.

    Agajany N, Gigi M, Ross J, Roth J, Eshel R, Constantini S, Bassan H (2019) The impact of neonatal posthemorrhagic hydrocephalus of prematurity on family function at preschool age. Early Hum Dev 137(2019):104827. https://doi.org/10.1016/j.earlhumdev.2019.104827

    Article  PubMed  Google Scholar 

  13. 13.

    Brouwer AJ, van Stam C, Venema MU, Koopman C, Groenendaal F, de Vries LS (2012) Cognitive and neurological outcome at the age of 5-8 years of preterm infants with post-hemorrhagic ventricular dilatation requiring neurosurgical intervention. Neonatology 101:210–216. https://doi.org/10.1159/000331797

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Costello AM, Hamilton PA, Baudin J, Townsend J, Bradford BC, Stewart AL, Reynolds EOR (1988) Prediction of neurodevelopmental impairment at four years from brain ultrasound appearance of very preterm infants. Dev Med Child Neurol 30:711–722. https://doi.org/10.1111/j.1469-8749.1988.tb14633.x

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Fletcher JM, Landry SH, Bohan TP, Davidson KC, Brookshire BL, Lachar D, Kramer LA, Francis DJ (1997) Effects of intraventricular hemorrhage and hydrocephalus on the long-term neurobehavioral development of preterm very-low-birthweight infants. Dev Med Child Neurol 39:596–606. https://doi.org/10.1111/j.469-8749.1997.tb07495.x

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Gigi M, Roth J, Eshel R, Constantini S, Bassan H (2018) Health-related quality of life after post-haemorrhagic hydrocephalus in children born preterm. Dev Med Child Neurol 61(3):343–349. https://doi.org/10.1111/dmcn.14012

    Article  PubMed  Google Scholar 

  17. 17.

    Holwerda JC, van Braeckel KNJA, Roze E, Hoving EW, Maathuis CGB, Brouwer OF, Martjin A, Bos AF (2016) Functional outcome at school age of neonatal post-hemorrhagic ventricular dilatation. Early Hum Dev 96(2016):15–20. https://doi.org/10.1016/.earlhumdev.2016.02.005

    Article  PubMed  Google Scholar 

  18. 18.

    Lean RE, Han RH, Smyser TA, Kenley JK, Shimony JS, Rogers CE, Limbrick DD Jr, Smyser CD (2019) Altered neonatal white and gray matter microstructure is associated with neurodevelopmental impairments in very preterm infants with high-grade brain injury. Pediatr Res 86(3):365–374. https://doi.org/10.1038/s41390-019-0461-1

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    LeFlore JL, Broyles RS, Pritchard MA, Engle WD (2003) Value of neurosonography in predicting subsequent cognitive and motor development in extremely low birth weight neonates. J Perinatol 23:629–634. https://doi.org/10.1038/sj.jp.7211009

    Article  PubMed  Google Scholar 

  20. 20.

    Mangano FT, Altaye M, McKinstry RC, Shimony JS, Powell SK, Phillips JM et al (2016) Diffusion tensor imaging study of pediatric patients with congenital hydrocephalus: 1-year postsurgical outcomes. J Neurosurg Pediatr 18(3):306–319. https://doi.org/10.3171/2016.2.PEDS15628

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Roth SC, Baudin J, McCormick DC, Edwards AD, Townsend J, Stewart AL, Reynolds EOR (1993) Relation between ultrasound appearance of the brain of very preterm infants and neurodevelopmental impairment at eight years. Dev Med Child Neurol 35:755–768. https://doi.org/10.1111/j.1469-8749.1993.tb11727.x

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Strahle JM, Triplett RL, Alexopoulos D, Smyser TA, Rogers CE, Limbrick DD Jr, Smyser CD (2019) Impaired hippocampal development and outcomes in very preterm infants with perinatal brain injury. NeuroImage 22(2019):101787. https://doi.org/10.1016/j.nicl.2019.101787

    Article  PubMed  Google Scholar 

  23. 23.

    Shang Q, Ma CY, Lu N, Yan Y-B, Wu Z-R, Li J-J et al (2015) Clinical study of cerebral palsy in 408 children with periventricular leukomalacia. Exp Ther Med 9(4):1336–1344. https://doi.org/10.3892/etm.2015.2222

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Yu B, Guo Q, Fan G, Liu N (2011) Assessment of cortical visual impairment in infants with periventricular leukomalacia: a pilot event-related FMRI study. Korean J Radiol 12(4):463–472. https://doi.org/10.3348/kjr.2011.12.4.463

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Yi YG, Sung IY, Suk JS (2018) Comparison of second and third editions of the Bayley Scales in children with suspected developmental delay. Ann Rehabil Med 42(2):313–320. https://doi.org/10.5535/arm.2018.42.2.313

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Bode MM, DʼEugenio DB, Mettelman BB, Gross SJ. (2014) Predictive validity of the Bayley, Third Edition at 2 years for intelligence quotient at 4 years in preterm infants. J Dev Behav Pediatr 35(9):570–575. https://doi.org/10.1097/DBP.0000000000000110

    Article  PubMed  Google Scholar 

  27. 27.

    Niileksela CR, Reynolds MR (2019) Enduring the tests of age and time: Wechsler constructs across versions and revisions. Intelligence. 77:101403. https://doi.org/10.1016/j.intell.2019.101403

    Article  Google Scholar 

  28. 28.

    Arrington CN, Ware AL, Ahmed Y, Kulesz PA, Dennis M, Fletcher JM (2016) Are shunt revisions associated with IQ in congenital hydrocephalus? A meta-analysis. Neuropsychol Rev 26(4):329–339. https://doi.org/10.1007/s11065-016-9335-z

    Article  PubMed  Google Scholar 

  29. 29.

    Liu J, Chen X, Lewis G (2011) Childhood internalizing behaviour: analysis and implications. J Psychiatr Ment Health Nurs 18(10):884–894. https://doi.org/10.1111/j.1365-2850.2011.01743.x

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Liu J (2004) Childhood externalizing behavior: theory and implications. J Child Adolesc Psychiatr Nurs 17(3):93–103. https://doi.org/10.1111/j.1744-6171.2004.tb00003.x

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Eskandari R, Mcallister JP 2nd, Miller JM et al (2004) Effects of hydrocephalus and ventriculoperitoneal shunt therapy on afferent and efferent connections in the feline sensorimotor cortex. J Neurosurg 101(2 Suppl):196–210. https://doi.org/10.3171/ped.2004.101.2.0196

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to extend our appreciation to Prof. Kyu-Chang Wang from the Department of Neurosurgery at the National Cancer Center in Seoul, South Korea, for revising the manuscript.

Author information

Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Jalan Pasteur No. 38, Bandung, West Java, Indonesia

    Mirna Sobana & Danny Halim

  2. Research Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Jalan Pasteur No. 38, Bandung, West Java, Indonesia

    Danny Halim & Tri Hanggono Achmad

  3. Department of Biotechnology, School of Life Science and Technology, Bandung Institute of Technology, Bandung, West Java, Indonesia

    Jenifer Kiem Aviani

  4. Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia

    Uni Gamayani

  5. Department of Basic Medical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia

    Tri Hanggono Achmad

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  1. Mirna Sobana
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  2. Danny Halim
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  3. Jenifer Kiem Aviani
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  4. Uni Gamayani
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Contributions

Dr Sobana conceptualized and designed the study, did the literature screening, assessed study eligibility and quality, directed the discussion, and reviewed and revised the manuscript.

Dr Halim conceptualized and designed the study, did the literature screening, analyzed the data, assessed study eligibility and quality, directed the discussion, wrote, and reviewed and revised the manuscript.

Ms Aviani did the literature screening, assessed study eligibility and quality, carried out the statistical analysis, and reviewed and revised the manuscript.

Dr Gamayani conceptualized and designed the study, and wrote, reviewed, and revised the manuscript.

Dr Achmad conceptualized and designed the study, directed the discussion, wrote, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Mirna Sobana or Tri Hanggono Achmad.

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Sobana, M., Halim, D., Aviani, J.K. et al. Neurodevelopmental outcomes after ventriculoperitoneal shunt placement in children with non-infectious hydrocephalus: a meta-analysis. Childs Nerv Syst (2021). https://doi.org/10.1007/s00381-021-05051-9

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Keywords

  • Non-infectious hydrocephalus
  • Ventriculoperitoneal shunt
  • Disability
  • Mental development
  • Motoric development
  • Behavioral abnormalities
  • Meta-analysis