Abstract：
BACKGROUND: Pediatric hydrocephalus is a significant health burden globally, particularly in low- and middle-income countries. Data from specific regions such as KwaZulu-Natal, South Africa, are lacking. This study aimed to investigate pediatric hydrocephalus by comparing 4 distinct 5-year periods.
METHODS: Data were collected retrospectively (2003-2007, 2008-2012, and 2013-2017) and prospectively (2018-2022). Children (≤18 years old) treated for hydrocephalus were included. Data on demographics, referral patterns, etiology, treatment modalities, and outcomes were collected and analyzed.
RESULTS: A total of 3325 children were treated. The peak period was 2008-2012 (35.3%). Most children (51.4%) were from rural areas (P = 0.013), and 47.9% were referred from regional hospitals (P < 0.001). Boys (56.4%) and infants (60.2%) were predominant groups (P < 0.001). Postinfectious etiology (32.7%) was predominant (P < 0.001), particularly tuberculous meningitis (54.1%). Ventriculoperitoneal shunts were the mainstay treatment (84.2%), with notable complication rates (20.4%), including infections (9.6%). Human immunodeficiency virus co-infection was diagnosed in 2.5% of cases. Weekend procedures were associated with ventriculoperitoneal shunt complications (hazard ratio [HR] = 1.3, 95% confidence [CI]1.03-1.66, P = 0.03). Mortality rate was 7.9%, and age ≥1 year (HR = 2.43, 95% CI 1.87-3.17, P < 0.001), tertiary hospital referral (HR = 1.48, 95% CI 1.06-2.04, P = 0.019), ventriculoperitoneal shunt infection (HR = 3.63, 95% CI 2.66-4.95, P < 0.001), acute abdomen (HR = 2.17, 95% CI 1.11-4.25, P = 0.024), and pneumonia (HR = 7.32, odds ratio = 4.84-11.06, P < 0.001) were associated with mortality.
CONCLUSIONS: This study provides comprehensive insights into pediatric hydrocephalus in KwaZulu-Natal. Monitoring temporal trends and predictors of outcomes will guide future interventions to mitigate the burden of pediatric hydrocephalus in the region.
METHODS: Data were collected retrospectively (2003-2007, 2008-2012, and 2013-2017) and prospectively (2018-2022). Children (≤18 years old) treated for hydrocephalus were included. Data on demographics, referral patterns, etiology, treatment modalities, and outcomes were collected and analyzed.
RESULTS: A total of 3325 children were treated. The peak period was 2008-2012 (35.3%). Most children (51.4%) were from rural areas (P = 0.013), and 47.9% were referred from regional hospitals (P < 0.001). Boys (56.4%) and infants (60.2%) were predominant groups (P < 0.001). Postinfectious etiology (32.7%) was predominant (P < 0.001), particularly tuberculous meningitis (54.1%). Ventriculoperitoneal shunts were the mainstay treatment (84.2%), with notable complication rates (20.4%), including infections (9.6%). Human immunodeficiency virus co-infection was diagnosed in 2.5% of cases. Weekend procedures were associated with ventriculoperitoneal shunt complications (hazard ratio [HR] = 1.3, 95% confidence [CI]1.03-1.66, P = 0.03). Mortality rate was 7.9%, and age ≥1 year (HR = 2.43, 95% CI 1.87-3.17, P < 0.001), tertiary hospital referral (HR = 1.48, 95% CI 1.06-2.04, P = 0.019), ventriculoperitoneal shunt infection (HR = 3.63, 95% CI 2.66-4.95, P < 0.001), acute abdomen (HR = 2.17, 95% CI 1.11-4.25, P = 0.024), and pneumonia (HR = 7.32, odds ratio = 4.84-11.06, P < 0.001) were associated with mortality.
CONCLUSIONS: This study provides comprehensive insights into pediatric hydrocephalus in KwaZulu-Natal. Monitoring temporal trends and predictors of outcomes will guide future interventions to mitigate the burden of pediatric hydrocephalus in the region.
摘要：
背景：儿科脑积水在全球范围内造成巨大的健康负担，特别是在低收入和中等收入国家。来自夸祖鲁-纳塔尔省等特定地区的数据很少，南非。本研究旨在调查小儿脑积水的景观，比较四个不同的五年期间。
方法：回顾性收集数据（2003年至2007年，2008年至2012年和2013年至2017年）和前瞻性（2018年至2022年）。包括接受脑积水治疗的儿童（≤18岁）。人口统计数据，推荐模式，病因学，治疗方式，并对结局进行收集和分析.
结果：共3325名儿童接受治疗。高峰期为2008年至2012年（35.3%）。大多数(51.4%)来自农村地区(p=0.013)，47.9%来自地区医院，p=<0.001。男性(56.4%)和婴儿(60.2%)是主要群体(p<0.001)。感染后病因(32.7%)占主导地位(p<0.001)，尤其是结核性脑膜炎（54.1%）。脑室-腹膜分流术(VPS)是主要治疗方法(84.2%),并发症发生率显著（20.4%），包括感染（9.6%）。在2.5%的病例中诊断出HIV合并感染。周末手术与VPS并发症相关(HR1.3,CI:1.03-1.66,p=0.03)。死亡率为7.9%,年龄≥1岁(HR，2.43CI：1.87-3.17，p<0.001），三级医院转诊(HR1.48，CI：1.06-2.04，p=0.019)，VPS感染（HR，3.63CI：2.66-4.95，p<0.001），急腹症(HR2.17,CI:1.11-4.25,p=0.024)和肺炎(HR7.32,OR4.84-11.06,p<0.001)与死亡率相关.
结论：本研究为KZN儿童脑积水提供了全面的见解。监测时间趋势和结果预测因素将有助于指导旨在减轻该地区小儿脑积水负担的未来干预措施。
方法：回顾性收集数据（2003年至2007年，2008年至2012年和2013年至2017年）和前瞻性（2018年至2022年）。包括接受脑积水治疗的儿童（≤18岁）。人口统计数据，推荐模式，病因学，治疗方式，并对结局进行收集和分析.
结果：共3325名儿童接受治疗。高峰期为2008年至2012年（35.3%）。大多数(51.4%)来自农村地区(p=0.013)，47.9%来自地区医院，p=<0.001。男性(56.4%)和婴儿(60.2%)是主要群体(p<0.001)。感染后病因(32.7%)占主导地位(p<0.001)，尤其是结核性脑膜炎（54.1%）。脑室-腹膜分流术(VPS)是主要治疗方法(84.2%),并发症发生率显著（20.4%），包括感染（9.6%）。在2.5%的病例中诊断出HIV合并感染。周末手术与VPS并发症相关(HR1.3,CI:1.03-1.66,p=0.03)。死亡率为7.9%,年龄≥1岁(HR，2.43CI：1.87-3.17，p<0.001），三级医院转诊(HR1.48，CI：1.06-2.04，p=0.019)，VPS感染（HR，3.63CI：2.66-4.95，p<0.001），急腹症(HR2.17,CI:1.11-4.25,p=0.024)和肺炎(HR7.32,OR4.84-11.06,p<0.001)与死亡率相关.
结论：本研究为KZN儿童脑积水提供了全面的见解。监测时间趋势和结果预测因素将有助于指导旨在减轻该地区小儿脑积水负担的未来干预措施。
