Relationship of CSF Shunting and IQ in Children with Myelomeningocele: A Retrospective Analysis

Mapstone, Timothy B.; Rekate, Harold L.; Nulsen, Frank E.; Dixon, Morris S.; Glaser, Naomi; Jaffe, M. R.

doi:10.1159/000120166

Cited by 30 publications

(28 citation statements)

References 1 publication

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“…A number of studies have shown intellect to be normal in non-shunted children and well above that of children requiring shunting. 2,4 Our ® ndings agree with this, although our mean developmental quotient of 80 for nonshunted children is lower than the IQ scores in each of these studies. In our study, children who required only one shunt were no different from those not shunted, whereas the group shunted more than once functioned signi® cantly lower in all sub-tests.…”

Section: Discussionsupporting

confidence: 86%

Pre-school follow-up of a cohort of children with myelomeningocele in Cape Town, South Africa

Buccimazza

Molteno

Dunne

1999

Annals of Tropical Paediatrics

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A cohort of South African children with myelomeningocele was followed for 5 years. Fifty-three were from metropolitan Cape Town and 65 from rural areas including the tribal region of Transkei. The mean general developmental quotient (GQ) at 5 years of age was lower than that previously reported. Black and coloured children had lower GQs than white children, but there were no significant differences between those from the urban and the rural areas. Early closure of the lesion and delivery by caesarean section were associated with higher levels of general developmental functioning. Central nervous system infections and the placement of more than one shunt for hydrocephalus resulted in lower GQs. Lesions above L2 were associated with non-ambulation. Ambulation was more likely in children in Cape Town than in rural children. Urinary incontinence occurred more frequently in rural children and among those in lower socio-economic circumstances.

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Section: Discussionsupporting

confidence: 86%

Pre-school follow-up of a cohort of children with myelomeningocele in Cape Town, South Africa

Buccimazza

Molteno

Dunne

1999

Annals of Tropical Paediatrics

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“…3,15,35 The clinical consequences of a shunt infection include seizures, psychomotor retardation, reduced intelligence quotient, and increased mortality. 13,22,25,32,37,39 The rate of shunt infection reported varies considerably in the literature, but in recent studies the incidence typically ranges from 5% to 15%, with rates typically higher in high-risk groups such as preterm neonates and patients recently treated for shunt infection. 28,33,34,36,42 Evidence of a shunt infection often manifests within 2 months after surgery.…”

mentioning

confidence: 99%

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

Klimo

Poppel

Thompson

et al. 2014

PED

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Object The objective of this systematic review and meta-analysis was twofold: to answer the question “What is the evidence for the effectiveness of prophylactic intravenous antibiotics for infection prevention in shunt surgery?” and to make treatment recommendations based on the available evidence. Methods The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to prophylactic antibiotic use in children undergoing a shunt operation. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). A meta-analysis was conducted using a random-effects model to calculate a cumulative estimate of treatment effect using risk ratio (RR). Heterogeneity was assessed using chi-square and I2 statistics. A sensitivity analysis was also conducted. Based on the quality of the literature and the result of the meta-analysis, a recommendation was rendered (Level I, II, or III). Results Nine studies (4 Class I, 3 Class II, and 2 Class III) met our inclusion criteria. Of 7 randomized controlled trials (RCTs), 3 were downgraded from Class I to Class II because of significant quality issues, and all RCTs were potentially underpowered. In only 2 Class in retrospective cohort studies were preoperative antibiotic agents found to be protective against shunt infection. When data from the individual studies were pooled together, the infection rate in the prophylactic antibiotics group was 5.9% compared with 10.7% in the control group. Using a random-effects model, the cumulative RR was 0.55 (95% CI 0.38–0.81), indicating a protective benefit of prophylactic preoperative intravenous antibiotics. A sensitivity analysis of RCTs only (n = 7) also demonstrated a statistical benefit, but an analysis of higher-quality RCTs only (n = 4) did not. Conclusions Within the limits of this systematic review and meta-analysis, administration of preoperative antibiotic agents for shunt surgery in children was found to lower the infection risk (quality of evidence: Class II; strength of recommendation, Level II). Recommendation The use of preoperative antibiotic agents can be recommended to prevent shunt infection in patients with hydrocephalus. It was only by combining the results of the various underpowered studies (meta-analysis) that the use of preoperative antibiotics for shunt surgery in children was shown to lower the risk of shunt infection. Strength of Recommendation: Level II, moderate degree of clinical certainty.

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“…14,15 Interpreting such retrospective studies to help make decisions on individual patients leads to diculty because the shunted group presumably had more severe hydrocephalus initially. The biologic cost of untreated hydrocephalus must be evaluated.…”

Section: ± 13mentioning

confidence: 99%

Increased intracranial pressure in myelomeningocele (MMC) patients never shunted: Results of a prospective preliminary study

Iborra¹,

Pagès²,

Cuxart³

et al. 2000

Spinal Cord

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Study design: In some young adults non-shunted myelomeningocele (MMC) patients without symptoms or with unspeci®c clinical ®ndings, moderate or severe stabilised ventriculomegaly are observed in control CT scans. Physicians are then faced with the so-called`Arrested Hydrocephalus' (AH) syndrome. The present study is part of a prospective protocol in which patients with hydrocephalus associated with MMC and long-term clinical diagnosis of AH were included. Objectives: To evaluate myelomeningocele patients never shunted with clinical and/or CT scan criteria compatible with AH. Setting: Multidisciplinary Spina Bi®da Unit in a tertiary university hospital in Barcelona, Spain. Methods: Fourteen MMC patients were selected, in all of them, continuous intracranial pressure (ICP) monitoring was performed. Analysis of the ICP records was done using the method described by Bùrgesen in mmHg. All patients were also studied by intelligence quotient (IQ) testing before and after shunting. Results: The CT in all the study cases showed an Evans ratio 40.30. The majority of patients (11/14) presented continuous high or intermittently raised ICP (active or unstable compensated hydrocephalus group) and in three (3/14) cases we con®rmed the diagnosis of arrested hydrocephalus. There were no complications associated with ICP monitoring. Conclusions: In view of our results, we believe that in all non-shunted cases with clinical and/ or CT scan criteria compatible with AH, the use of an objective method, such as continuous ICP monitoring, is necessary to diagnose arrested hydrocephalus, and a more comprehensive method that includes extensive neuropsychological valoration should be developed for the diagnosis and treatment of arrested hydrocephalus. Sponsorship: Supported in part by Grant number 97-0923 from the Fondo de Investigaciones Sanitarias de la Seguridad Social (FISS). Spinal Cord (2000) 38, 495 ± 497

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Relationship of CSF Shunting and IQ in Children with Myelomeningocele: A Retrospective Analysis

Cited by 30 publications

References 1 publication

Pre-school follow-up of a cohort of children with myelomeningocele in Cape Town, South Africa

Pre-school follow-up of a cohort of children with myelomeningocele in Cape Town, South Africa

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

Increased intracranial pressure in myelomeningocele (MMC) patients never shunted: Results of a prospective preliminary study

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