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Yang MMH, Hader W, Bullivant K, Brindle M, Riva-Cambrin J. Calgary Shunt Protocol, an adaptation of the Hydrocephalus Clinical Research Network shunt protocol, reduces shunt infections in children. J Neurosurg Pediatr 2019; 23:559-567. [PMID: 30797206 DOI: 10.3171/2018.10.peds18420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The shunt protocol developed by the Hydrocephalus Clinical Research Network (HCRN) was shown to significantly reduce shunt infections in children. However, its effectiveness had not been validated in a non-HCRN, small- to medium-volume pediatric neurosurgery center. The present study evaluated whether the 9-step Calgary Shunt Protocol, closely adapted from the HCRN shunt protocol, reduced shunt infections in children. METHODS The Calgary Shunt Protocol was prospectively applied at Alberta Children's Hospital from May 23, 2013, to all children undergoing any shunt procedure. The control cohort consisted of children undergoing shunt surgery between January 1, 2009, and the implementation of the Calgary Shunt Protocol. The primary outcome was the strict HCRN definition of shunt infection. Univariate analyses of the protocol, individual elements within, and known confounders were performed using Student t-test for measured variables and chi-square tests for categorical variables. Multivariable logistic regression was performed using stepwise analysis. RESULTS Two-hundred sixty-eight shunt procedures were performed. The median age of patients was 14 months (IQR 3-61), and 148 (55.2%) were male. There was a significant absolute risk reduction of 10.0% (95% CI 3.9%-15.9%) in shunt infections (12.7% vs 2.7%, p = 0.004) after implementation of the Calgary Shunt Protocol. In univariate analyses, chlorhexidine was associated with fewer shunt infections than iodine-based skin preparation solution (4.1% vs 12.3%, p = 0.02). Waiting ≥ 20 minutes between receiving preoperative antibiotics and skin incision was also associated with a reduction in shunt infection (4.5% vs 14.2%, p = 0.007). In the multivariable analysis, only the overall protocol independently reduced shunt infections (OR 0.19 [95% CI 0.06-0.67], p = 0.009), while age, etiology, procedure type, ventricular catheter type, skin preparation solution, and time from preoperative antibiotics to skin incision were not significant. CONCLUSIONS This study externally validates the published HCRN protocol for reducing shunt infection in an independent, non-HCRN, and small- to medium-volume pediatric neurosurgery setting. Implementation of the Calgary Shunt Protocol independently reduced shunt infection risk. Chlorhexidine skin preparation and waiting ≥ 20 minutes between administration of preoperative antibiotic and skin incision may have contributed to the protocol's quality improvement success.
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Affiliation(s)
- Michael M H Yang
- 1Section of Pediatric Neurosurgery, Division of Neurosurgery, Department of Clinical Neurosciences; and
| | - Walter Hader
- 1Section of Pediatric Neurosurgery, Division of Neurosurgery, Department of Clinical Neurosciences; and
| | - Kelly Bullivant
- 1Section of Pediatric Neurosurgery, Division of Neurosurgery, Department of Clinical Neurosciences; and
| | - Mary Brindle
- 2Section of Pediatric Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jay Riva-Cambrin
- 1Section of Pediatric Neurosurgery, Division of Neurosurgery, Department of Clinical Neurosciences; and
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Diwakar K, Hader WJ, Soraisham A, Amin H, Tang S, Bullivant K, Kamaluddeen M, Lodha A. Long-Term Neurodevelopmental and Growth Outcomes of Premature Infants Born at <29 week Gestational Age with Post-Hemorrhagic Hydrocephalus Treated with Ventriculo-Peritoneal Shunt. Indian J Pediatr 2017; 84:662-669. [PMID: 28367615 DOI: 10.1007/s12098-017-2319-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/10/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare long-term neurodevelopmental and growth (NDG) outcomes at 3 y corrected gestational age (GA) in premature infants with grade ≥ III intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus who were treated with ventriculo-peritoneal shunt with those who were not treated with shunt. METHODS In a retrospective cohort study, NDG outcomes were compared between preterm infants of <29 wk GA with IVH treated with shunt (IVHS) and IVH with no shunt (IVHNS). This was a single centre study. The primary outcome was moderate to severe cerebral palsy (CP). RESULTS Of 1762 preterm infants who survived to discharge, 90 had grade ≥ III IVH. Infants in IVHS group had more grade IV IVH than IVHNS (p < 0.05). Seventy percent of the patients in IVHNS groups had no hydrocephalus. IVHS group had increased CP (76% vs. 30%; p 0.003), and higher odds of CP after controlling for GA and IVH grade [odds ratio (OR); 4.23 (1.38 to 13.00)]. Growth delay was not different between groups. CONCLUSIONS Infants with IVHS are at increased risk of CP but not growth delay.
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Affiliation(s)
- K Diwakar
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Walter J Hader
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
- Section of Pediatric Neurosurgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - A Soraisham
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Harish Amin
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Selphee Tang
- Alberta Health Services, Calgary, Alberta, Canada
| | - Kelly Bullivant
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Majeeda Kamaluddeen
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Abhay Lodha
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
- Alberta Health Services, Calgary, Alberta, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
- Department of Pediatrics, Cumming School of Medicine, Foothills Medical Centre, C211-1403 29 St NW, Calgary, AB,, T2N2T9, Canada.
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