Ventriculoperitoneal shunt outcomes among infants

Ventriculoperitoneal shunts (VPSs) are used for the treatment of hydrocephalus. Here we analyzed the outcomes of VPS placements in 24 infants to determine the risk factors for shunt failure. The infants had undergone the initial VPS operation in our hospital between March 2005 and December 2013. They were observed until the end of January 2014. We obtained Kaplan-Meier curves and performed a multivariate Cox regression analysis of shunt failure. Of the 24 cases, the median (range) values for gestational age, birth weight, and birth head circumference (HC) were 37 (27-39) wks, 2,736 (686-3,788) g, and 35.3 (23.0-45.3) cm, respectively. The total number of shunt procedures was 45. Shunt failure rates were 0.51/shunt and 0.0053/shunt/year. Shunt infection rates were 0.13/shunt and 0.0014/shunt/year. The Kaplan-Meier analysis revealed an increased risk for shunt failure in infants < 1 month old or in the HC > 90%tile. The Cox regression analysis yielded hazard ratios (HRs) of 2.93 (95% confidence interval (CI), 0.96-10.95, p=0.059) for age < 1 month, and 4.46 (95%CI:1.20-28.91, p=0.023) for the HC > 90%tile. The multivariate Cox regression analysis showed adjusted HRs of 17.56 (95%CI:2.69-202.8, p=0.001) for age < 1 month, and 2.95 (95%CI:0.52-24.84, p=0.228) for the HC > 90%tile. Our findings thus revealed that the risk factors for shunt failure in infants include age < 1 month at the initial VPS placement.