Risk factors of complications and long-term neurodevelopmental delay after ventriculoperitoneal shunt of hydrocephalus after intraventricular hemorrhage in premature infants

Background Premature intraventricular haemorrhage (IVH) is associated with high morbidity and poor prognosis. Approximately 25–30% of severe (grade III/IV) patients have post-haemorrhagic hydrocephalus. Ventriculoperitoneal shunting is the main therapy for permanent surgery in patients with post-haemorrhagic hydrocephalus. Postoperative complications, neurodevelopmental delay, and epilepsy are poor prognoses, and the risk factors for these prognoses need to be assessed. Objective To summarize the clinical characteristics of premature infants who received ventriculoperitoneal shunts (V-P shunts) after IVH and post-haemorrhage hydrocephalus and to assess the postoperative complications and risk factors for neurodevelopmental delay 2 years after surgery. Methods A total of 161 premature infants diagnosed with IVH and post-haemorrhage hydrocephalus at Peking University First Hospital between 2008 and 2021 were recruited and regularly followed-up for 2 years after surgery. Risk factors for surgical complications and neurodevelopmental delays were assessed. Results In total, 161 patients were included in this study, of whom 139 were included in the statistical analysis. 54 patients (38.8%) experienced complications 2 years after ventriculoperitoneal shunt placement. 48 (34.5%) patients had epilepsy and 96 (69.0%) had developmental delays. Abnormal mental response and abnormal tone (p = 0.020; p = 0.015), seizures (p = 0.049), and external ventricular drainage (p = 0.028) were the risk factors for V-P shunt associated complications. Abnormal tone (p = 0.037) was the independent risk factors for postoperative complications of V-P shunts. Abnormal tone (p = 0.004), severe IVH (grade III/IV) (p = 0.004), and seizures (p = 0.001) were risk factors for epilepsy. Mechanical ventilation (p = 0.033), seizures (p = 0.014), and severe IVH (p = 0.047) were risk factors for developmental delay. Conclusion The risk factors for postoperative complications include abnormal mental response, abnormal tone, seizures, and external ventricular drainage. Abnormal tone was the independent risk factor for postoperative complications of V-P shunts. Risk factors for epilepsy include abnormal tone, severe IVH, and convulsive seizures. The risk factors for developmental delay include mechanical ventilation, seizures, and severe IVH.