Ventriculo-Peritoneal Shunt Infections in Infants and Children

Objective: To determine the rate and the type of ventriculoperitoneal (VP) shunt infections in infants and children admitted to King Fahad Hofuf hospital of Al-Ahsaa area at the Eastern Province of Saudi Arabia.Methods: From mid 2003 to end of 2006; VP shunt infection episodes were reviewed. Once infection was suspected, a cerebrospinal fluid (CSF) sample was taken and empirical antibiotics were recommended. Once infection was confirmed, VP shunt was removed and external ventricular drainage (EVD) was inserted until CSF became sterile after which a new shunt was inserted.Results: 25.9% of patients with VP shunts had infections which represents 29.3% of the procedures. 40% of infected patients had recurrent episodes. 59.1% of infections occurred throughout the first two months following insertion. Single pathogen was isolated in each episode. Pseudomonas auerginosa represented 50% of isolated pathogens compared with 18.2% with Staphylococcus epidermidis.Conclusions: There is a high incidence of VP shunt infections in King Fahad Hofuf hospital when compared with other international centres. Gram negative organisms are the most common cause of the infection

Traumatic brain injury in pediatric age group; predictors of outcome in Pediatric Intensive Care Unit

Objective: To determine predictors for outcomes of traumatic brain injury (TBI) in infants and children younger than twelve years admitted to our pediatric intensive care units (PICU).Methods: This is a retrospective cohort study from 2004-5, done at the PICU of King Fahad Hofuf Hospital, Eastern Province, Saudi Arabia. One hundred and six patients with TBI; 65 boys and 41 girls ages 12 or under, with a mean age of 5.7 years, were included. Of them, 11.3% died (Deaths group), 11% survived with neurological deficits (ND-group), and 77% survived with no neurological deficits (NND-group). The potential predictors for death or neurological deficits were examined.Results: 83% of deaths had initial Glascow coma scale (GCS) of ≤ 4/15, 50% of ND had initial GCS ≤ 8 and 27% of NND had GCS < 12. The initial brain CT was abnormal in 92% of deaths and ND groups, but in only 37% of NND. Combined brain pathologies were found in 92% of deaths, 63% of ND and only in 5% of NND. Hypotension was seen in 67% of deaths, 17% ND and only in 1% of NND. Mechanical ventilation was required in all deaths and more than half of ND. Liver enzymes were high in 50% of deaths and 66% of ND but in only 20% of NND. Serum albumin was low in 33% of deaths, 42% of ND and only 1% NND.Conclusion: Glasgow coma score, brain CT findings, combined brain pathologies, hypotension, high liver enzymes and low serum albumin predict outcome after TBI in pediatric age group