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PP02.7 – 2580: Influence of antimicrobial-impregnated external ventricular catheters on infection rates of preterm infants with posthaemorrhagic hydrocephalus – a retrospective, descriptive analysis
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EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
dardized batteries: Brunet Lézine before 3 years old, WPPSI-III at 3 and 5 years old, WISC-IV at 8 years old. Results: Among 60 pregnancies, 12 abortions, one fetal death, one lost outcome, and 46 newborn (76% of the pregnancies). Among the sixteen younger children (<3 y old), one had a severe developmental delay, the others had normal developmental skills. Among the thirty older children (3 to 10 years old), one had a severe intellectual disability (Mowat-Wilson syndrome), nine (30%) had specific learning disabilities (with IQ >70), and 20 (66%) had normal IQ and learning skills. Conclusion: A rare risk of a severe cognitive impairment (2/46 patients; 4.3%) cannot be excluded and must be shared with the women. Nevertheless, 30% of patients had specific learning disabilities and two thirds had a normal outcome, which is consistent with other small series of isolated ACC
PP02.5 - 2943 Neurological outcome in MMC patients after fetal surgery – Results from the Zurich cohort D. Wille, U. Moehrlen, M. Meuli, I. Scheer, A. Meyer, A. Klein. Dept. of Pediatric Neurology, University Childrens’s Hospital, Zurich, Switzerland Objective: The purpose of this study was to investigate the neurological outcome of patients with meningomyelocele treated with fetal closure in Zurich. Methods: 14 patients were included, of two data were collected retrospectively, 12 were followed prospectively by a detailed evaluation protocol. We investigated the anatomical spinal level in utero before surgery by in utero MR imaging. The functional spinal level at birth, 3 months, 6 months and 12 months of age was compared to the anatomical level in utero. Chiari II-malformation and remission of hindbrain herniation over the course was investigated by MRI. Data of head circumference, shunt placement, bladder dysfunction and development were collected. Our results were compared to the results of the MOMS study (A randomized trial of prenatal versus postnatal repair of myelomeningocele. Adzick et al. NEJM, 2011 Mar 17;364(11):993–1004). Results: Anatomical level in utero ranged between L1 to L5. According to the anatomical level the functional level after surgery was two or more levels better in 28%, level of function one level better in 21%, no difference was seen in 43%, level of function two level worse in 7%. Interestingly 75% of our patients had partial motor innervation below the functional level. Before surgery Chiari II-malformation was detected in all 14 patients, after fetal surgery we had no evidence of hindbrain herniation in any. In 46.1% shunt placement was necessary. 66% had neurogenic bladder dysfunction. Conclusion: Our results from this small cohort show nearly the same results as reported in the MOMS trial, especially regarding shunt placement. A part of our patients showed a relevant partial motor innervation below the level, it is to discuss if this could be a result of fetal intervention, just as the low frequency of shunt placement and complete demission of hindbrain herniation.
PP02.6 - 2349 Unilateral ventricular dilatation. Follow up during the first 2 years of life A.I. Toma, A.I. Cuzino, A. Cozinov, R.G. Olteanu. Life Memorial Hospital, University Titu Maiorescu, Bucharest, Romania Objective: To investigate if the unilateral ventricular dilatation detected by fetal and neonatal ultrasound is associated with neurological abnormalities during the first 2 years of life. Methods: A number of 1319 neonates were examined by head ultrasound on day of life 1 and 3. Prenatal histories and ultrasound were collected in all the cases. Theere were selected the cases with unilateral ventricular dilation that were examined by head ultrasound at 1, 2, 4, 6 months and by clinical and neurologic
19s (2015) S1 – S152
examination and, if needed, specific imaging and neurologic investigations at 1, 2, 4 6, 12 months and 2 years. Results: There were detected the dilatation of the left ventricle (18cases); posterior horn of the left ventricle (88cases), posterior horn of the right ventricle (12cases). All these cases were asymptomatic during the neonatal period and only 6/88 cases with left posterior horn dilatation and 1/12 of the cases with right posterior horn dilatation developed neurologic abnormalities. All these cases were identified before delivery by fetal ultrasound. The abnormalities identified were: tonus abnormalities – hypotonic at 4 and 6 months with normalization at 12 months in 3/88cases with left posterior horn dilatation and 1/12cases with dilatation of the posterior horn of the right ventricle. There were delays in the fine motor skills in all the 6 symptomatic cases with left ventricular dilation and 1/12 cases with right ventricular dilation. The cases of ventricular dilatation that manifested with neurologic abnormalities, were all detected as ventricular dilatation by fetal ultrasound. Conclusion: The antenatal ultrasound predicted the appearance of the abnormalities. No case with abnormal development would have been missed without head ultrasound in the neonatal period.
PP02.7 - 2580 Influence of antimicrobial-impregnated external ventricular catheters on infection rates of preterm infants with posthaemorrhagic hydrocephalus – a retrospective, descriptive analysis F. Lindinger, C. Czaba, K. Klebermass-Schrehof. Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Vienna, Vienna, Austria Objective: The objective of our retrospective study was to evaluate whether the use of antimicrobial impregnated EVDs could decrease the risk of ventricular infection. Methods: We included all preterm infants who had developed PHH and were born below the 32nd gestational week and were treated with EVDs between 2001 and 2011. Following variables were evaluated: birth weight, week of gestation, grade of the intraventricular haemorrhage, quantity of catheter revision, quantity of definite ventriculoperitoneal (VP) shuntings, rate of ventriculitis, which was diagnosed only if the liquor showed positive culture results and rate of mortality. Statistical analysis was done by SPSS 20.0 using MannWhitney U-test and χ2 -test. Results: 26 patients were treated with EVDs before 2007 (without antimicrobial impregnation, = Group A), 21 patients were treated after 2007 (with EVDs with antimicrobial impregnation, = Group B). Group A: mean gestational weight: 1036 g (±474.209), mean gestational week: 26.7 (±1.80), 2 patients suffered from IVH II° (7.7%), 16 patients from IVH III° (61.5%) and 8 patients from IVH IV° (30.8%), Mortality rate: 57.7%. Group B: mean gestational weight: 1115 g (±494.902), mean gestational week: 27.3 (±2.32), 1 patient suffered from IVH II° (4.8%), 10 patients from IVH III° (47.6%) and 10 patients from IVH IV° (47.6%), Mortality rate: 33.3%. No infection Infection Total Significance EVD without antimicrobial impregnation 21 5 (19.2%) 26 EVD with antimicrobial impregnation 20 1 (4.8%) 21 p=0.150 Total 41 6 47. Conclusion: After implementation of antimicrobial impregnated ventricular catheters, there has been a marked decrease of secondary ventriculitis of EVDs from 19.2% to 4.8%.
PP02.8 - 2549 Foetal cerebellar haemorrhage: A case-series with neurodevelopmental follow-up C.M.P.C.D. Peeters-Scholte, N.A. Aziz, S.C. Wiggers-de Bruine, F.J. Klumper, S.J. Steggerda. Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands Background: The cerebellum is an extremely rapidly developing
EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
dardized batteries: Brunet Lézine before 3 years old, WPPSI-III at 3 and 5 years old, WISC-IV at 8 years old. Results: Among 60 pregnancies, 12 abortions, one fetal death, one lost outcome, and 46 newborn (76% of the pregnancies). Among the sixteen younger children (<3 y old), one had a severe developmental delay, the others had normal developmental skills. Among the thirty older children (3 to 10 years old), one had a severe intellectual disability (Mowat-Wilson syndrome), nine (30%) had specific learning disabilities (with IQ >70), and 20 (66%) had normal IQ and learning skills. Conclusion: A rare risk of a severe cognitive impairment (2/46 patients; 4.3%) cannot be excluded and must be shared with the women. Nevertheless, 30% of patients had specific learning disabilities and two thirds had a normal outcome, which is consistent with other small series of isolated ACC
PP02.5 - 2943 Neurological outcome in MMC patients after fetal surgery – Results from the Zurich cohort D. Wille, U. Moehrlen, M. Meuli, I. Scheer, A. Meyer, A. Klein. Dept. of Pediatric Neurology, University Childrens’s Hospital, Zurich, Switzerland Objective: The purpose of this study was to investigate the neurological outcome of patients with meningomyelocele treated with fetal closure in Zurich. Methods: 14 patients were included, of two data were collected retrospectively, 12 were followed prospectively by a detailed evaluation protocol. We investigated the anatomical spinal level in utero before surgery by in utero MR imaging. The functional spinal level at birth, 3 months, 6 months and 12 months of age was compared to the anatomical level in utero. Chiari II-malformation and remission of hindbrain herniation over the course was investigated by MRI. Data of head circumference, shunt placement, bladder dysfunction and development were collected. Our results were compared to the results of the MOMS study (A randomized trial of prenatal versus postnatal repair of myelomeningocele. Adzick et al. NEJM, 2011 Mar 17;364(11):993–1004). Results: Anatomical level in utero ranged between L1 to L5. According to the anatomical level the functional level after surgery was two or more levels better in 28%, level of function one level better in 21%, no difference was seen in 43%, level of function two level worse in 7%. Interestingly 75% of our patients had partial motor innervation below the functional level. Before surgery Chiari II-malformation was detected in all 14 patients, after fetal surgery we had no evidence of hindbrain herniation in any. In 46.1% shunt placement was necessary. 66% had neurogenic bladder dysfunction. Conclusion: Our results from this small cohort show nearly the same results as reported in the MOMS trial, especially regarding shunt placement. A part of our patients showed a relevant partial motor innervation below the level, it is to discuss if this could be a result of fetal intervention, just as the low frequency of shunt placement and complete demission of hindbrain herniation.
PP02.6 - 2349 Unilateral ventricular dilatation. Follow up during the first 2 years of life A.I. Toma, A.I. Cuzino, A. Cozinov, R.G. Olteanu. Life Memorial Hospital, University Titu Maiorescu, Bucharest, Romania Objective: To investigate if the unilateral ventricular dilatation detected by fetal and neonatal ultrasound is associated with neurological abnormalities during the first 2 years of life. Methods: A number of 1319 neonates were examined by head ultrasound on day of life 1 and 3. Prenatal histories and ultrasound were collected in all the cases. Theere were selected the cases with unilateral ventricular dilation that were examined by head ultrasound at 1, 2, 4, 6 months and by clinical and neurologic
19s (2015) S1 – S152
examination and, if needed, specific imaging and neurologic investigations at 1, 2, 4 6, 12 months and 2 years. Results: There were detected the dilatation of the left ventricle (18cases); posterior horn of the left ventricle (88cases), posterior horn of the right ventricle (12cases). All these cases were asymptomatic during the neonatal period and only 6/88 cases with left posterior horn dilatation and 1/12 of the cases with right posterior horn dilatation developed neurologic abnormalities. All these cases were identified before delivery by fetal ultrasound. The abnormalities identified were: tonus abnormalities – hypotonic at 4 and 6 months with normalization at 12 months in 3/88cases with left posterior horn dilatation and 1/12cases with dilatation of the posterior horn of the right ventricle. There were delays in the fine motor skills in all the 6 symptomatic cases with left ventricular dilation and 1/12 cases with right ventricular dilation. The cases of ventricular dilatation that manifested with neurologic abnormalities, were all detected as ventricular dilatation by fetal ultrasound. Conclusion: The antenatal ultrasound predicted the appearance of the abnormalities. No case with abnormal development would have been missed without head ultrasound in the neonatal period.
PP02.7 - 2580 Influence of antimicrobial-impregnated external ventricular catheters on infection rates of preterm infants with posthaemorrhagic hydrocephalus – a retrospective, descriptive analysis F. Lindinger, C. Czaba, K. Klebermass-Schrehof. Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Vienna, Vienna, Austria Objective: The objective of our retrospective study was to evaluate whether the use of antimicrobial impregnated EVDs could decrease the risk of ventricular infection. Methods: We included all preterm infants who had developed PHH and were born below the 32nd gestational week and were treated with EVDs between 2001 and 2011. Following variables were evaluated: birth weight, week of gestation, grade of the intraventricular haemorrhage, quantity of catheter revision, quantity of definite ventriculoperitoneal (VP) shuntings, rate of ventriculitis, which was diagnosed only if the liquor showed positive culture results and rate of mortality. Statistical analysis was done by SPSS 20.0 using MannWhitney U-test and χ2 -test. Results: 26 patients were treated with EVDs before 2007 (without antimicrobial impregnation, = Group A), 21 patients were treated after 2007 (with EVDs with antimicrobial impregnation, = Group B). Group A: mean gestational weight: 1036 g (±474.209), mean gestational week: 26.7 (±1.80), 2 patients suffered from IVH II° (7.7%), 16 patients from IVH III° (61.5%) and 8 patients from IVH IV° (30.8%), Mortality rate: 57.7%. Group B: mean gestational weight: 1115 g (±494.902), mean gestational week: 27.3 (±2.32), 1 patient suffered from IVH II° (4.8%), 10 patients from IVH III° (47.6%) and 10 patients from IVH IV° (47.6%), Mortality rate: 33.3%. No infection Infection Total Significance EVD without antimicrobial impregnation 21 5 (19.2%) 26 EVD with antimicrobial impregnation 20 1 (4.8%) 21 p=0.150 Total 41 6 47. Conclusion: After implementation of antimicrobial impregnated ventricular catheters, there has been a marked decrease of secondary ventriculitis of EVDs from 19.2% to 4.8%.
PP02.8 - 2549 Foetal cerebellar haemorrhage: A case-series with neurodevelopmental follow-up C.M.P.C.D. Peeters-Scholte, N.A. Aziz, S.C. Wiggers-de Bruine, F.J. Klumper, S.J. Steggerda. Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands Background: The cerebellum is an extremely rapidly developing