A retrospective study of infections after primary VP shunt placement in the newborn with myelomeningocele without prophylactic antibiotics

Purpose We aim to correlate the frequency of infections after ventriculoperitoneal (VP) shunt placement in neonates with myelomeningocele (MMC) who did not receive prophylactic antibiotics to the timing of VP shunt placement and the frequency of cerebrospinal fluid (CSF) leakage at the MMC wound. Methods Fifty-nine newborns with MMC underwent VP shunt insertion in the period 1983-2007. We reviewed retrospectively all records. Results After MMC closure, 24 out of 59 newborns had an infection. The relative risk (RR; 95%) of having an infection is significantly higher [RR= 4,69 (1.145397-19.23568; P=.03761817)], and neuroinfection showed a tendency towards RR=3.5 (.7067445-17.03112; P=.15414095) in newborns without symptomatic hydrocephalus at birth when we had a wait-and-watch policy (late shunt placement) compared with newborns with prompt shunt placement. The RR (95%) of having an infection [RR= 6,8 (3.314154-13.95228; P=1.235e-07)] and also neuroinfections [RR= 4,76 (2.043019-11.09025; P=.00044478)] was highly significant if the child presented with MMC wound with CSF leakage before VP shunt insertion (Table 3). Conclusions Centers with a conservative antibiotic policy should be even more careful to avoid CSF leakage before shunt placement as this gives a highly significant increased risk of both infections in total and neuroinfections, and they should reconsider this conservative policy in newborns with MMC due to the significantly high infection rate.