Top

Published in:

01-05-2018 | Original Paper

Early elective delivery for fetal ventriculomegaly: are neurosurgical and medical complications mitigated by this practice?

Authors: Clinton D. Morgan, Travis R. Ladner, George L. Yang, Marjorie N. Moore, Russell D. Parks, William F. Walsh, John C. Wellons, Chevis N. Shannon

Published in: Child's Nervous System | Issue 5/2018

Abstract

Purpose

Antenatally diagnosed ventriculomegaly (VM) requires the balance of risks of neurological injury with premature delivery. The purpose of this study was to evaluate outcomes related to early elective delivery due to fetal VM at our institution.

Methods

We retrospectively assessed 120 babies (2008–2012) with antenatally diagnosed fetal VM. Inclusion criteria for (“early”) cohort were (1) elective delivery occurred for expedited neurosurgical intervention between 32 and 36 weeks EGA and (2) fetal VM noted on official antenatal ultrasound. The comparative “near term” cohort differed only in that delivery occurred at 37+ weeks EGA. Statistical significance for comparative analyses set a priori at p < 0.05.

Results

Babies electively delivered early had a lower birthweight (p < 0.0001), greater ventricle width (p < 0.0001), and underwent initial CSF diversion sooner (p = 0.014). The early cohort (n = 22), compared to near term (n = 50), had a lower birthweight (p < 0.0001), greater ventricle width (p < 0.0001), and underwent initial CSF diversion sooner (p = 0.014). The early cohort required more repeat procedures: (45 vs. 22% p = 0.021), and VPS removals after VPS infections (41 vs. 12%, p = 0.010). Additionally, newborn respiratory failure (32 vs. 6%, p = 0.037) was more common. Finally, of four babies who died in the early cohort, 2/4 died for prematurity-associated pulmonary hypoplasia.

Conclusions

While early elective delivery for fetal VM expedites intervention for rapidly expanding ventricles, few benefits were identified. Our study concluded those infants that were delivered earlier had increased VPS infections, repeat neurosurgical procedures, and medical co-morbidities. A multi-institutional prospective observational study would be needed in order to confirm the clinical implications of such practice.

Ashton DM (2010) Elective delivery at less than 39 weeks. Curr Opin Obstet Gynecol 22(6):506–510. https://doi.org/10.1097/GCO.0b013e3283404eb4 CrossRefPubMed

Bruinsma N, Stobberingh EE, Herpers MJ, Vles JS, Weber BJ, Gavilanes DA (2000) Subcutaneous ventricular catheter reservoir and ventriculoperitoneal drain-related infections in preterm infants and young children. Clin Microbiol Infect 6(4):202–206. https://doi.org/10.1046/j.1469-0691.2000.00052.x CrossRefPubMed

Cardoza JD, Goldstein RB, Filly RA (1988) Exclusion of fetal ventriculomegaly with a single measurement: the width of the lateral ventricular atrium. Radiology 169(3):711–714. https://doi.org/10.1148/radiology.169.3.3055034 CrossRefPubMed

Carnaghan H, Pereira S, James CP, Charlesworth PB, Ghionzoli M, Mohamed E et al (2014) Is early delivery beneficial in gastroschisis? J Pediatr Surg 49:928–933; discussion 933CrossRefPubMed

Engle WA (2008) Surfactant-replacement therapy for respiratory distress in the preterm and term neonate. Pediatrics 121(2):419–432. https://doi.org/10.1542/peds.2007-3283 CrossRefPubMed

Engle WA, Kominiarek MA (2008) Late preterm infants, early term infants, and timing of elective deliveries. Clin Perinatol 35:325–341, viCrossRefPubMed

Engle WA, Tomashek KM (2007) Wallman C: {“late-preterm”} infants: a population at risk. Pediatrics 120(6):1390–1401. https://doi.org/10.1542/peds.2007-2952 CrossRefPubMed

Goynumer G, Yayla M, Arisoy R, Turkmen O (2014) The criterion value of fetal cerebral lateral ventricular atrium width for diagnosis of ventriculomegaly. Clin Exp Obstet Gynecol 41:67–71PubMed

Hadidi A, Subotic U, Goeppl M, Waag K-LL (2008) Early elective cesarean delivery before 36 weeks vs late spontaneous delivery in infants with gastroschisis. J Pediatr Surg 43(7):1342–1346. https://doi.org/10.1016/j.jpedsurg.2007.12.050 CrossRefPubMed

10.

Hidaka N, Ishii K, Kanazawa R, Miyagi A, Irie A, Hayashi S, Mitsuda N (2014) Perinatal characteristics of fetuses with borderline ventriculomegaly detected by routine ultrasonographic screening of low-risk populations. J Obstet Gynaecol Res 40(4):1030–1036. https://doi.org/10.1111/jog.12298 CrossRefPubMed

11.

Jensen JR, White WM, Coddington CC (2013) Maternal and neonatal complications of elective early-term deliveries. Mayo Clin Proc 88(11):1312–1317. https://doi.org/10.1016/j.mayocp.2013.07.009 CrossRefPubMed

12.

Logghe HL, Mason GC, Thornton JG, Stringer MD (2005) A randomized controlled trial of elective preterm delivery of fetuses with gastroschisis. J Pediatr Surg 40(11):1726–1731. https://doi.org/10.1016/j.jpedsurg.2005.07.047 CrossRefPubMed

13.

Madar J, Richmond S, Hey E (1999) Surfactant-deficient respiratory distress after elective delivery at “term”. Acta Paediatr 88(11):1244–1248. https://doi.org/10.1080/080352599750030365 CrossRefPubMed

14.

Pople IK, Bayston R, Hayward RD (1992) Infection of cerebrospinal fluid shunts in infants: a study of etiological factors. J Neurosurg 77(1):29–36. https://doi.org/10.3171/jns.1992.77.1.0029 CrossRefPubMed

15.

Spader HS, Hertzler DA, Kestle JR, Jay R-C (2015) Risk factors for infection and the effect of an institutional shunt protocol on the incidence of ventricular access device infections in preterm infants. J Neurosurg Pediatr 15(2):156–160. https://doi.org/10.3171/2014.9.PEDS14215 CrossRefPubMed

Title: Early elective delivery for fetal ventriculomegaly: are neurosurgical and medical complications mitigated by this practice?
Authors: Clinton D. Morgan
Travis R. Ladner
George L. Yang
Marjorie N. Moore
Russell D. Parks
William F. Walsh
John C. Wellons
Chevis N. Shannon
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 5/2018
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-017-3662-0

At a glance: The STEP trials

Springer Medicine

Early elective delivery for fetal ventriculomegaly: are neurosurgical and medical complications mitigated by this practice?

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2018

Does a systematic algorithm matter for the management of ventriculoperitoneal shunt perforations of the gastrointestinal tract?

Resting state signal latency predicts laterality in pediatric medically refractory temporal lobe epilepsy

Surgical treatment of a type IV cystic sacrococcygeal teratoma with intraspinal extension utilizing a posterior-anterior-posterior approach: a case report

Publication rates of the abstracts presented at the annual meeting of International Society for Pediatric Neurosurgery

26th Congress of the European Society for Pediatric Neurosurgery (ESPN) Bonn-Germany, 6-9 May 2018

Medulloblastoma, WNT-activated/SHH-activated: clinical impact of molecular analysis and histogenetic evaluation