Brain growth after surgical treatment for infant postinfectious hydrocephalus in Sub-Saharan Africa: 2-year results of a randomized trial.
Brain growth after surgical treatment for infant postinfectious hydrocephalus in Sub-Saharan Africa: 2-year results of a randomized trial.
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DOI：
10.3171/2021.2.peds20949
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发表时间：
2021-09-01
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影响因子：
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通讯作者：
Warf BC
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作者：
Schiff SJ;Kulkarni AV;Mbabazi-Kabachelor E;Mugamba J;Ssenyonga P;Donnelly R;Levenbach J;Monga V;Peterson M;Cherukuri V;Warf BC
婴儿脑积水，特别是感染后病因的婴儿脑积水，是撒哈拉以南非洲的主要公共卫生负担。这项研究的作者旨在确定乌干达婴儿感染后脑积水的手术治疗是否会导致持续、长期的脑发育和认知结果的改善。作者在乌干达Mbale的一个单一中心进行了一项试验，将患有感染后脑积水的婴儿(年龄180天)随机分为内窥镜第三脑室造口加脉络丛烧灼术(ETV+CPC；n=51)或脑室-腹膜分流术(VPS；n=49)。两年后，他们用贝利婴儿发育量表第三版(BSID-III)评估发育结果，并用CT扫描评估脑体积(原始的和年龄和性别归一化的)。89名婴儿接受了2年结局评估。在BSID-III认知评分(p=0.17)或脑容量(p=0.36)方面，两个手术治疗组之间没有显著差异，因此将它们放在一起进行分析。原始脑体积在基线和两年之间增加(p<；0.001)，但这种增加几乎只发生在第一年(p<；0.001)。脑体积正常的患者比例从基线的15.2%增加到1年的50.0%，但随后下降到2年的17.8%。21.3%的患者在基线到第二年之间和76.7%的患者在第一年和第二年之间出现了显著的脑体积丢失。第一年的脑生长程度与第二年的脑体积变化程度无关。两年后的脑体积与所有BSID-III评分和BSID-III较基线的变化呈显著正相关。在撒哈拉以南非洲，即使婴儿感染后脑积水得到成功的手术治疗，治疗后早期的脑发育在第二年也停滞不前。虽然这一发现的原因尚不清楚，但它进一步强调了初级感染预防和缓解策略的重要性，以及优化儿童的环境以最大限度地发挥大脑生长潜力的重要性。临床试验注册号：NCT01936272(Clinicaltrials.gov)
Hydrocephalus in infants, particularly that with a postinfectious etiology, is a major public health burden in Sub-Saharan Africa. The authors of this study aimed to determine whether surgical treatment of infant postinfectious hydrocephalus in Uganda results in sustained, long-term brain growth and improved cognitive outcome. The authors performed a trial at a single center in Mbale, Uganda, involving infants (age < 180 days old) with postinfectious hydrocephalus randomized to endoscopic third ventriculostomy plus choroid plexus cauterization (ETV+CPC; n = 51) or ventriculoperitoneal shunt (VPS; n = 49). After 2 years, they assessed developmental outcome with the Bayley Scales of Infant Development, Third Edition (BSID-III), and brain volume (raw and normalized for age and sex) with CT scans. Eighty-nine infants were assessed for 2-year outcome. There were no significant differences between the two surgical treatment arms in terms of BSID-III cognitive score (p = 0.17) or brain volume (p = 0.36), so they were analyzed together. Raw brain volumes increased between baseline and 2 years (p < 0.001), but this increase occurred almost exclusively in the 1st year (p < 0.001). The fraction of patients with a normal brain volume increased from 15.2% at baseline to 50.0% at 1 year but then declined to 17.8% at 2 years. Substantial normalized brain volume loss was seen in 21.3% patients between baseline and year 2 and in 76.7% between years 1 and 2. The extent of brain growth in the 1st year was not associated with the extent of brain volume changes in the 2nd year. There were significant positive correlations between 2-year brain volume and all BSID-III scores and BSID-III changes from baseline. In Sub-Saharan Africa, even after successful surgical treatment of infant postinfectious hydrocephalus, early posttreatment brain growth stagnates in the 2nd year. While the reasons for this finding are unclear, it further emphasizes the importance of primary infection prevention and mitigation strategies along with optimizing the child’s environment to maximize brain growth potential. Clinical trial registration no.: NCT01936272 (clinicaltrials.gov)