Clinical Research
Preterm-related posthemorrhagic hydrocephalus: Review of our institutional series with a long-term follow-up
Hidrocefalia poshemorrágica del prematuro: revisión de nuestra serie a largo plazo
Leído
17
Vecesse ha leído el artículo
8
Total PDF
9
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1130147322000252" "issn" => "11301473" "doi" => "10.1016/j.neucir.2022.03.001" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "546" "copyright" => "Sociedad Española de Neurocirugía" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2023;34:122-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S252984962200079X" "issn" => "25298496" "doi" => "10.1016/j.neucie.2022.11.009" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "546" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2023;34:122-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>" "titulo" => "Preterm-related posthemorrhagic hydrocephalus: Review of our institutional series with a long-term follow-up" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "122" "paginaFinal" => "127" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hidrocefalia poshemorrágica del prematuro: revisión de nuestra serie a largo plazo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1493 "Ancho" => 1677 "Tamanyo" => 82949 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Proportion of patients free of ventricular obstruction during follow-up in months according to treatment protocol.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pablo Miranda, Juan Antonio Simal, Estela Plaza, Giovanni Pancucci, Raquel Escrig, Nuria Boronat, Roberto Llorens" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Pablo" "apellidos" => "Miranda" ] 1 => array:2 [ "nombre" => "Juan Antonio" "apellidos" => "Simal" ] 2 => array:2 [ "nombre" => "Estela" "apellidos" => "Plaza" ] 3 => array:2 [ "nombre" => "Giovanni" "apellidos" => "Pancucci" ] 4 => array:2 [ "nombre" => "Raquel" "apellidos" => "Escrig" ] 5 => array:2 [ "nombre" => "Nuria" "apellidos" => "Boronat" ] 6 => array:2 [ "nombre" => "Roberto" "apellidos" => "Llorens" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1130147322000252" "doi" => "10.1016/j.neucir.2022.03.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147322000252?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S252984962200079X?idApp=UINPBA00004B" "url" => "/25298496/0000003400000003/v1_202305031136/S252984962200079X/v1_202305031136/en/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1130147322000410" "issn" => "11301473" "doi" => "10.1016/j.neucir.2022.03.002" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "547" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Neurocirugia. 2023;34:128-38" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "A meta-analysis of Lateral supraorbital vs mini Pterional approach in the outcome of rupture and unruptured noncomplex aneurysms’ surgery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "128" "paginaFinal" => "138" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metaanálisis entre el abordaje subfrontal y minipterional en los aneurismas cerebrales no complejos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0060" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2873 "Ancho" => 2925 "Tamanyo" => 349700 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Flowchart of the study selection process.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "George Fotakopoulos, Hugo Andrade-Barazarte, Brotis Alexandros, Juha Hernesniemi" "autores" => array:4 [ 0 => array:2 [ "nombre" => "George" "apellidos" => "Fotakopoulos" ] 1 => array:2 [ "nombre" => "Hugo" "apellidos" => "Andrade-Barazarte" ] 2 => array:2 [ "nombre" => "Brotis" "apellidos" => "Alexandros" ] 3 => array:2 [ "nombre" => "Juha" "apellidos" => "Hernesniemi" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529849622000788" "doi" => "10.1016/j.neucie.2022.11.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849622000788?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147322000410?idApp=UINPBA00004B" "url" => "/11301473/0000003400000003/v1_202305030948/S1130147322000410/v1_202305030948/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1130147322000240" "issn" => "11301473" "doi" => "10.1016/j.neucir.2022.02.005" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "545" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2023;34:112-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>" "titulo" => "Predictive model of resection in endoscopic endonasal approach for pituitary adenomas based on anatomical limits" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "112" "paginaFinal" => "121" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Modelo predictivo de resección en abordaje endoscópico endonasal de adenomas hipofisarios basado en límites anatómicos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 837 "Ancho" => 1005 "Tamanyo" => 64518 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The SD coefficient results from the division between the maximum tumor diameter at the suprasellar level (yellow line) and the diameter of the sellar diaphragm (blue line).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Martorell-Llobregat, Javier Abarca-Olivas, Pablo González-López, José Sánchez-Payá, Antonio Picó-Alfonso, Pedro Moreno-López" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Martorell-Llobregat" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Abarca-Olivas" ] 2 => array:2 [ "nombre" => "Pablo" "apellidos" => "González-López" ] 3 => array:2 [ "nombre" => "José" "apellidos" => "Sánchez-Payá" ] 4 => array:2 [ "nombre" => "Antonio" "apellidos" => "Picó-Alfonso" ] 5 => array:2 [ "nombre" => "Pedro" "apellidos" => "Moreno-López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529849622000806" "doi" => "10.1016/j.neucie.2022.11.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849622000806?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147322000240?idApp=UINPBA00004B" "url" => "/11301473/0000003400000003/v1_202305030948/S1130147322000240/v1_202305030948/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>" "titulo" => "Preterm-related posthemorrhagic hydrocephalus: Review of our institutional series with a long-term follow-up" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "122" "paginaFinal" => "127" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pablo Miranda, Juan Antonio Simal, Estela Plaza, Giovanni Pancucci, Raquel Escrig, Nuria Boronat, Roberto Llorens" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Pablo" "apellidos" => "Miranda" "email" => array:1 [ 0 => "mirandalloret@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan Antonio" "apellidos" => "Simal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Estela" "apellidos" => "Plaza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Giovanni" "apellidos" => "Pancucci" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Raquel" "apellidos" => "Escrig" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Nuria" "apellidos" => "Boronat" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Roberto" "apellidos" => "Llorens" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neurocirugía, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hidrocefalia poshemorrágica del prematuro: revisión de nuestra serie a largo plazo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1495 "Ancho" => 1675 "Tamanyo" => 86455 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Proportion of patients free of ventricular obstruction during follow-up in months according to treatment protocol.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Brain hemorrhage in preterm patients secondary to germinal matrix bleeding represents a leading cause of morbidity and mortality in preterm and very low birth weight infants, with serious long-term neurocognitive consequences and a high incidence of intraventricular hemorrhage and secondary hydrocephalus.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1,2</span></a> Diagnosis and treatment of preterm-related posthemorrhagic hydrocephalus is not well standardized despite recent systematic reviews and treatment protocols.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3–5</span></a> In most patients, the only effective treatment for hydrocephalus still requires a ventriculoperitoneal shunt, but even the ideal type of shunt or the best moment to implant it remains controversial.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4–6</span></a> Moreover, complications of ventriculoperitoneal shunts in these patients may appear very later on<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a> and therefore series with a long-term follow-up are desirable although seldom available.</p><p id="par0010" class="elsevierStylePara elsevierViewall">With this background in mind, the primary objective of the present investigation was to review and evaluate our results and complications in the treatment of shunted preterm-related posthemorrhagic hydrocephalus in the last four decades in our hospital, with a long-term follow-up. Our group reported in 2010 the results of the first 103 cases in this series.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> Some years later we had introduced a number of changes in our treating protocol (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>): as a secondary objective we seek to determine if this changes in our protocol were associated to different clinical results.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">For the present study we included those preterm patients with germinal matrix and intraventricular hemorrhage who eventually required a definitive ventriculoperitoneal shunt in our hospital from 1982 to 2020. A total of 133 patients were included for analysis. One patient in the series was born at term (gestational age at delivery<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>37 weeks) but was included in the series because the diagnosis of intraventricular hemorrhage had taken place by ultrasonography during pregnancy three weeks earlier along an episode of maternal preeclampsia.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Medical records were retrospectively reviewed and the following data were retrieved for analysis: sex, degree of prematurity, weight at birth and at surgery and the degree of intra- ventricular hemorrhage on the first ultrasonography examination according to the classification of Papile et al.,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> proximal obstruction, infection, neurological outcome, radiological progression towards ventricular collapse, last clinical follow-up.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Proximal obstruction of the shunt was diagnosed in patients requiring shunt revision for signs and symptoms of shunt dysfunction when minimal or no CSF flow was obtained through the ventricular catheter. Whenever infection or disconnection of the shunt was present at the same time, the case was not included for analysis as a case of obstruction independently of what was observed during the revision procedure.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Degree of neurological impairment was assessed when possible by neonatologist using validated scales (Bayley Scale of Infant Development (BSID) and the Gross Motor Function Classification System (GMFCS)). When this evaluation was not available, neurological impairment was estimated qualitatively in a four-stage classification (normal development; mild impairment but independent for most daily life activities; moderate impairment requiring assistance for most daily life activities and special educative institutions; severe impairment with deep cerebral palsy).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Radiological progression towards ventricular collapse was also evaluated qualitatively in the last cerebral CT scan or brain MR. Ventricular size was classified as dilated, normal sized, small or collapsed. Ventricles were classified as collapsed when CSF was barely visible around the ventricular catheter inside the ventricle. Interrater agreement of this observation was evaluated using Cohen's kappa coefficient.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Bivariate correlations were determined with parametric and non-parametric tests. Survival analysis was evaluated using the Kaplan–Meier method. Different survival curves were compared using the log-rank and Breslow tests. SPSS version 20.0 (Chicago, Ill., USA) software was used for statistical analysis. Tests were two-tailed with a probability level set at a value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The main clinical characteristics of the cases in this series are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Our series comprised 133 patients, 70 boys and 63 girls. Mean gestational age at birth was 30.23 weeks and mean weight at birth, 1514<span class="elsevierStyleHsp" style=""></span>g whereas at surgery mean weight was 2434<span class="elsevierStyleHsp" style=""></span>g. Intraventricular hemorrhage according to the classification of Papile et al.,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> was grade 2 in 24 patients, grade 3 in 79 patients and grade 4 in 30 patients. Mean age at surgery was 58 days. In most cases, a fixed-pressure ball-in-cone valve was implanted, while programmable devices were used as the first valve in 16 patients. Mean follow-up was over 9 years.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Main clinical outcomes are summarized in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. There were 15 cases of infection. We registered 65 cases of initial ventricular shunt obstruction. Most cases of obstruction appeared soon after shunt insertion: the incidence of initial shunt obstruction in the first year was 30.8%, and it reached 36% of patients by the second year of follow-up. Two thirds of our patients showed a normal neuropsychological development or mild impairment. At last radiological follow-up, 61 patients showed very small or collapsed ventricles. Cohen's kappa concordance index for ventricular size qualitative classification was moderate, 0.69.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">122 patients were treated using the classical protocol and the last 11 cases were treated according to the updated protocol. Demographic, clinical and radiological characteristics among these groups showed no significant differences. Similarly, clinical outcomes were comparable between patients in both protocols. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows Kaplan–Meier survival plot for shunts in patients treated under different protocols: log rank (Mantel–Cox) test showed no significant difference in the probability of survival of the shunt (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.48).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Preterm- related posthemorrhagic hydrocephalus continues to be one of the main causes leading to a ventriculoperitoneal shunt surgery in infants. This intervention is particularly problematic due to several facts: the inherent fragility of these patients; associated significant brain damage leading to abnormal compliance; an immature immune response increasing the risk of infection; the existence of open fontanels that will close later on modifying intracranial pressure, CSF and venous dynamics; the presence of intraventricular blood debris that facilitate shunt obstruction; and a significant risk of intraventricular tabication, among others.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1,2,10–14</span></a> Despite excellent recent trials and literature reviews, a standard protocol of diagnosis and treatment is still unavailable.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4,15,16</span></a> New modalities of treatment and introduction of new technologies require continuous redefinition of management and evaluation of our results to validate such protocols.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15,17–20</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In our series, the need of a definitive shunt after preterm-related germinal matrix and intraventricular hemorrhage has decreased in the last decades: 45 patients were implanted a shunt from 2001 to 2010, compared to only 23 patients from 2011 to 2020, while the absolute number of premature infants remained equivalent. Other authors have reported similar observations<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a> and this decrease in shunt surgeries is probably related not only to improvements in perinatal care and the use of surgical temporizing measures, but also to tailoring the indication of surgery according to objective parameters.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">19,22,23</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Changes in our protocol of management result from a steady incorporation of recommendations that have been widely accepted rather than a purportedly developed treatment algorithm. Shunt infection in the short term, and obstruction associated to overdrainage in the long run are the most difficult complications to treat in our experience.</p><p id="par0075" class="elsevierStylePara elsevierViewall">On one hand, incidence of shunt obstruction in our series is close to 40% after two years of follow-up, but patients showing late obstructions are not uncommon<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8,11</span></a> and therefore most patients cannot be considered shunt-independent, need extended follow-up and do not get rid of the threat of obstruction barely never. The most common cause of ventricular catheter obstruction was blockage due to choroid plexus. This complication can probably be decreased with the systematic use of the frontal horn as the entry point in the ventricle.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a> Additionally, many of our patients will develop very small sized or collapsed ventricles, which expose them to a higher risk of headaches and shunt failures.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">7,8,25,26</span></a> In our experience, when a siphoning-retarding device is not incorporated into a shunt, the evolution towards ventricular collapse in a working shunt is the rule rather than the exception. However, the time of onset of this collapse may vary greatly and therefore long-term follow-up of these patients is essential. The preliminary use of programmable shunts in our series of patients has shown to be safe in concordance with other authors,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6,27</span></a> but in our short experience they are not enough to prevent the occurrence of ventricular collapse, making siphoning-retarding devices still required. Symptomatic overdrainage shows a significant latency regarding radiological findings, and therefore thorough clinical evaluation and long-term follow-up are necessary to identify this complication.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">On the other hand, the use of ventriculogaleal shunts, better integration of clinical and radiological information and strict adherence to antibiotic prophylaxis may safely delay the time of surgery and help to decrease the rate of shunt infection.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15,17,28</span></a> The incidence of shunt infection in patients treated lately has also decreased in our series although differences are not statistically significant among our treatment protocols. Along with previous observations we believe that this decrease in infections is the result of a combination of different steps rather than secondary to a single intervention.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Despite these previous considerations, it is neuropsychological development the most relevant outcome in these preterm patients and it should be specifically evaluated through dedicated scales. In our series only a minority of patients underwent these tests since they are significantly time consuming. Notwithstanding, our results are comparable to similar series.<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">29,30</span></a> Neuroendoscopic lavage may offer an improvement in the neurodevelopmental outcome in these patients, but clinical results still need to be generalized.<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16,20,31</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Finally, our study has several limitations. The number of patients and length of follow-up among the classic and the updated protocol is very different and comparisons among these groups is considered preliminary. As a retrospective investigation, this study is subjected to memory and classification biases. Repeated comparisons could lead to spurious associations while lack of power may not detect significant ones. Qualitative measurements of ventricular collapse or developmental delay show moderate correlation and lack external validation. Further prospective and collaborative research in this topic is ongoing and results are awaited.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">This research has not received specific aid from public sector agencies, the commercial sector or non-profit entities.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1891508" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1636900" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1891509" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1636899" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-12-28" "fechaAceptado" => "2022-03-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1636900" "palabras" => array:5 [ 0 => "Poshemorrhagic hydrocephalus" 1 => "Preterm" 2 => "Shunt" 3 => "Complication" 4 => "Development" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1636899" "palabras" => array:5 [ 0 => "Hidrocefalia poshemorrágica" 1 => "Prematuro" 2 => "Derivación" 3 => "Complicaciones" 4 => "Neurodesarrollo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Preterm-related posthemorrhagic hydrocephalus is a major cause of neurological impairment and a common indication for a ventriculoperitoneal shunt in infants that are prone to diverse complications. Protocols of diagnosis and treatment are in continuous evolution and require evaluation of their results.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To review the clinical characteristics and results of a series of preterm-related posthemorrhagic hydrocephalus needing a definitive shunt from 1982 to 2020 in our institution. As a secondary objective we evaluated the safety of the changes in our protocol of treatment from 2015.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retrospective review, clinical investigation.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">133 patients were implanted a shunt in the study period. Shunt infection was diagnosed in 15 patients. Proximal shunt obstruction as the first complication was diagnosed in 30% of cases at one year, 37% at two years and 46% at five years. 61 patients developed very small or collapsed ventricles at last follow-up. Two thirds of our patients achieved normal neurological development or mild impairment. Changes in protocol did not significantly modify clinical results although improvement in most outcomes was observed. Mean follow-up was over nine years.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Clinical outcomes are comparable to previous reported data. Changes in protocol proved to be safe and improved our results. Programmable shunts can be used safely in preterm patients although they may not prevent tendency towards ventricular collapse, which is very common after long follow-up.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La hidrocefalia poshemorrágica del prematuro continúa siendo una causa importante de lesión cerebral perinatal y una indicación frecuente de cirugía derivativa valvular en un grupo de pacientes particularmente vulnerable y expuesto a complicaciones. Los protocolos de diagnóstico y tratamiento están en continua evolución y requieren un análisis de los resultados asociados a ellos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Revisar las características clínicas y los resultados de tratamiento en una serie de prematuros con hidrocefalia poshemorrágica en los que se implantó una derivación ventriculoperitoneal permanente en nuestro hospital entre 1982 y 2000. Como objetivo secundario evaluamos la seguridad de los cambios introducidos en nuestro protocolo desde 2015.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio clínico retrospectivo, serie de casos.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">133 prematuros requirieron una derivación ventriculoperitoneal permanente en el tiempo de estudio. En 15 de ellos se diagnosticó una infección del sistema de derivación. La obstrucción proximal de la derivación como primera complicación posquirúrgica ocurrió en un 30% de los pacientes al primer año, en el 37% de los pacientes a los dos años y en el 46% de los casos a los 5 años de seguimiento. 61 pacientes desarrollaron un colapso ventricular clínico o radiológico. Dos tercios de los pacientes presentaron un desarrollo psicomotor normal o un retraso de carácter leve. Los cambios incorporados en nuestro protocolo de tratamiento no modificaron la evolución clínica significativamente, aunque se asociaron a una evolución globalmente más favorable. La media de seguimiento fue superior a los 9 años.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los resultados clínicos presentados se encuentran en línea con las series publicadas, Los cambios incorporados en nuestro protocolo actualizado demostraron ser seguros y pueden asociarse a una evolución más favorable. Los sistemas de derivación programable pueden ser empleados con seguridad en pacientes prematuros si bien no evitan de forma aislada el desarrollo del colapso ventricular, el cual es extraordinariamente frecuente a medida que se prolongan los tiempos de seguimiento.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1495 "Ancho" => 1675 "Tamanyo" => 86455 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Proportion of patients free of ventricular obstruction during follow-up in months according to treatment protocol.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Historic control \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Updated protocol \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time lapse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1980–2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2015–2020 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Temporizing measures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lumbar punctureTransfontanelar puncture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lumbar punctureVentricular access deviceVentriculosubgaleal shunt \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Need for treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical status, head circumference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical status, ventricular index, doppler \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Indication of permanent shunt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinically stable patient with persistent ventriculomegaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinically stable – weight<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>1500<span class="elsevierStyleHsp" style=""></span>g – ventricular index above p97 despite temporizing measures \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antibiotic prophylaxis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VariableAmoxicilin-clavulanic frequently used \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ConstantVancomicin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>ceftazdime \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Introduction of ventricular catheter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parietal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Frontal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of valve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fixed low pressure ball-in-cone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Programmable<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>siphon retarding device \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Access to peritoneal cavity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Guided by trocar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Open mini-laparotomy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of neuroendoscopy lavage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not implemented \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Selected cases (tabication) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3162056.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Classic protocol and changes introduced.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">All patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Before 2015 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">After 2015 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">N [boys: girls]</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">133 [70: 63] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122 [63:59] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 [7:4] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean gestational age at birth [weeks]</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.32<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean weight at birth [g]</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1514<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>702 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1563<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>697.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">970.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>226.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean age at surgery [days]</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean weight at surgery [g]</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2606.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1542 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2626.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1707.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2390.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>543.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Papile grade of haemorrhage at diagnosis</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Type of shunt</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fixed pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">117 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">117 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Programmable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antibiotic prophylaxis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Follow-up [months] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">106.38<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>80.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">112.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>22.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3162054.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of all patients.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Incidence of shunt obstruction at 1 year</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (30.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Incidence of infection of shunt after 1st surgery</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (11.27%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Neuropsychological development</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 (48.12%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mild developmental delay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (16.54%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate developmental delay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (15.78%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Deep developmental delay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (19.54%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Very small or collapsed ventricles at last follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 (45.86%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3162055.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Clinical outcome [all patients].</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraventricular hemorrhage and posthemorrhagic hydrocephalus in preterm infants: diagnosis, classification, and treatment options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Valdez Sandoval" 1 => "P. Hernández Rosales" 2 => "D.G. Quiñones Hernández" 3 => "E.A. Chavana Naranjo" 4 => "V. García Navarro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Child's Nerv Syst" "fecha" => "2019" "volumen" => "35" "paginaInicial" => "917" "paginaFinal" => "927" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0165" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of intraventricular hemorrhage in preterm infants with low birth weight" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Inagaki" 1 => "T. Kawaguchi" 2 => "T. Yamahara" 3 => "N. Kitamura" 4 => "T. Ryu" 5 => "Y. Kinoshita" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Acta Neurochir (Suppl)" "fecha" => "2012" "paginaInicial" => "173" "paginaFinal" => "175" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0170" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Wellons" 1 => "C.N. Shannon" 2 => "R. Holubkov" 3 => "J. Riva-Cambrin" 4 => "A.V. Kulkarni" 5 => "D.D. Limbrick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg Ped" "fecha" => "2017" "volumen" => "20" "paginaInicial" => "19" "paginaFinal" => "29" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0175" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early versus late treatment of posthaemorrhagic ventricular dilatation: results of a retrospective study from five neonatal intensive care units in The Netherlands" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.S. de Vries" 1 => "K.D. Liem" 2 => "K. van Dijk" 3 => "B.J. Smit" 4 => "L. Sie" 5 => "K.J. Rademaker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/080352502317285234" "Revista" => array:6 [ "tituloSerie" => "Acta Paediatrica" "fecha" => "2002" "volumen" => "91" "paginaInicial" => "212" "paginaFinal" => "217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11952011" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0180" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventriculoperitoneal shunt as a primary neurosurgical procedure in newborn posthemorrhagic hydrocephalus: report of a series of 47 shunted patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Romero" 1 => "B. Ros" 2 => "F. Rius" 3 => "L. Gonzalez" 4 => "J.M. Medina" 5 => "A. Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Child's Nerv Syst" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "91" "paginaFinal" => "97" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0185" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of neonatal hydrocephalus: Feasibility of use and safety of two programmable (Sophy and Polaris) valves" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.F. Martínez-Lage" 1 => "M.J. Almagro" 2 => "I.S. Rincón" 3 => "M.A. Pérez-Espejo" 4 => "C. Piqueras" 5 => "R. Alfaro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Child's Nerv Syst" "fecha" => "2008" "volumen" => "24" "paginaInicial" => "549" "paginaFinal" => "556" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0190" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Shunt-related headaches: the slit ventricle syndromes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.L. Rekate" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Child's Nerv Syst" "fecha" => "2008" "volumen" => "24" "paginaInicial" => "423" "paginaFinal" => "430" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0195" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Initial proximal obstruction of ventriculoperitoneal shunt in patients with preterm-related posthaemorrhagic hydrocephalus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Miranda" 1 => "J.a. Simal" 2 => "F. Menor" 3 => "E. Plaza" 4 => "R. Conde" 5 => "C. Botella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000329622" "Revista" => array:6 [ "tituloSerie" => "Pediatr Neurosurg" "fecha" => "2011" "volumen" => "47" "paginaInicial" => "88" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21952534" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0200" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship of cerebral intraventricular hemorrhage and early childhood neurologic handicaps" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.A. Papile" 1 => "G. Munsick-Bruno" 2 => "A. Schaefer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatrics" "fecha" => "1983" "volumen" => "103" "paginaInicial" => "273" "paginaFinal" => "277" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0205" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Robinson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg Ped" "fecha" => "2012" "volumen" => "29" "paginaInicial" => "997" "paginaFinal" => "1003" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0210" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurosurgical treatment of progressive posthemorrhagic ventricular dilation in preterm infants: a 10-year single-institution study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.D. Limbrick" 1 => "A. Mathur" 2 => "J.M. Johnston" 3 => "R. Munro" 4 => "J. Sagar" 5 => "T. Inder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg Ped" "fecha" => "2010" "volumen" => "6" "paginaInicial" => "224" "paginaFinal" => "230" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0215" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical treatment problems of hydrocephalus caused by spontaneus intraventricular hemorrhage in prematurely born children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Mihajlovic" 1 => "V. Bogosavljevic" 2 => "I. Nikolic" 3 => "M. Mrdak" 4 => "N. Repac" 5 => "V. Scepanovic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5137/1019-5149.JTN.6244-12.1" "Revista" => array:6 [ "tituloSerie" => "Turk Neurosurg" "fecha" => "2013" "volumen" => "23" "paginaInicial" => "593" "paginaFinal" => "599" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24101305" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0220" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Posthemorrhagic hydrocephalus in the preterm infant: current evidence in diagnosis and treatment]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Bravo" 1 => "P. Cano" 2 => "R. Conde" 3 => "M. Gelabert" 4 => "P. Pulido" 5 => "B. Ros" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurocirugia" "fecha" => "2011" "volumen" => "22" "paginaInicial" => "381" "paginaFinal" => "400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22031158" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0225" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraventricular hemorrhage and posthemorrhagic hydrocephalus in the preterm infant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Miranda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Minerva Pediatr" "fecha" => "2010" "volumen" => "62" "paginaInicial" => "79" "paginaFinal" => "89" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20212401" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0230" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Mazzola" 1 => "A. Catherine" 2 => "A.F.A.K. Choudhri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg Ped" "fecha" => "2014" "volumen" => "14" "paginaInicial" => "8" "paginaFinal" => "23" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0235" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TROPHY registry study design: a prospective, international multicenter study for the surgical treatment of posthemorrhagic hydrocephalus in neonates" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "U.W. Thomale" 1 => "G. Cinalli" 2 => "A.V. Kulkarni" 3 => "S. Al-Hakim" 4 => "J. Roth" 5 => "A. Schaumann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Child's Nerv Syst" "fecha" => "2019" "volumen" => "35" "paginaInicial" => "613" "paginaFinal" => "619" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0240" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of the use of ventricular access devices and ventriculosubgaleal shunts in posthaemorrhagic hydrocephalus: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.M. Fountain" 1 => "A. Chari" 2 => "D. Allen" 3 => "G. James" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Child's Nerv Syst." "fecha" => "2016" "volumen" => "32" "paginaInicial" => "259" "paginaFinal" => "267" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0245" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European perspective on the diagnosis and treatment of posthaemorrhagic ventricular dilatation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Brouwer" 1 => "M. Brouwer" 2 => "F. Groenendaal" 3 => "M. Benders" 4 => "A. Whitelaw" 5 => "L. de Vries" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Arch Dis Child Fetal Neonatal Ed" "fecha" => "2012" "paginaInicial" => "F50" "paginaFinal" => "F55" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0250" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment thresholds for intervention in posthaemorrhagic ventricular dilation: a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.S. De Vries" 1 => "F. Groenendaal" 2 => "K.D. Liem" 3 => "A. Heep" 4 => "A.J. Brouwer" 5 => "E. Van’t Verlaat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/archdischild-2017-314206" "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child Fetal Neonatal Ed" "fecha" => "2019" "volumen" => "104" "paginaInicial" => "F70" "paginaFinal" => "F75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29440132" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0255" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early endoscopic ventricular irrigation for the treatment of neonatal posthemorrhagic hydrocephalus: a feasible treatment option or not? A multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Etus" 1 => "G. Kahilogullari" 2 => "H. Karabagli" 3 => "A. Unlu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5137/1019-5149.JTN.18677-16.0" "Revista" => array:6 [ "tituloSerie" => "Turk Neurosurg" "fecha" => "2018" "volumen" => "28" "paginaInicial" => "137" "paginaFinal" => "141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27759873" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0260" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduced ventricular shunt rate in very preterm infants with severe intraventricular hemorrhage: an institutional experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Alan" 1 => "S. Manjila" 2 => "N. Minich" 3 => "N. Bass" 4 => "A.R. Cohen" 5 => "M. Walsh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg Ped" "fecha" => "2012" "volumen" => "10" "paginaInicial" => "357" "paginaFinal" => "364" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0265" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound measurements of the lateral ventricles in neonates: why, how and when? A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.J. Brouwer" 1 => "L.S. De Vries" 2 => "L. Pistorius" 3 => "K.J. Rademaker" 4 => "F. Groenendaal" 5 => "M.J. Benders" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1651-2227.2010.01830.x" "Revista" => array:6 [ "tituloSerie" => "Acta Paediatrica" "fecha" => "2010" "volumen" => "99" "paginaInicial" => "1298" "paginaFinal" => "1306" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20394588" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0270" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posthemorrhagic ventricular dilatation in preterm infants When best to intervene?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.M. Leijser" 1 => "S.P. Miller" 2 => "G. Van Wezel-Meijler" 3 => "A.J. Brouwer" 4 => "J. Traubici" 5 => "I.C. Van Haastert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/WNL.0000000000004984" "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2018" "volumen" => "90" "paginaInicial" => "E698" "paginaFinal" => "E706" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29367448" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0275" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 9: Effect of ventricular catheter entry point and position" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Kemp" 1 => "A.M. Flannery" 2 => "M.S. Tamber" 3 => "A.C. Duhaime" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg Ped" "fecha" => "2014" "volumen" => "14" "paginaInicial" => "72" "paginaFinal" => "76" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0280" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Shunt overdrainage: reappraisal of the syndrome and proposal for an integrative model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Ros" 1 => "S. Iglesias" 2 => "J. Linares" 3 => "L. Cerro" 4 => "J. Casado" 5 => "M.A. Arráez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/jcm10163620" "Revista" => array:5 [ "tituloSerie" => "J Clin Med" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "3620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34441916" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0285" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The slit ventricle syndrome: advances based on technology and understanding" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.L. Rekate" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatric Neurosurg" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "259" "paginaFinal" => "263" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0290" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posthemorrhagic hydrocephalus in preterm infants: long-term follow-up and shunt-related complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Reinprecht" 1 => "W. Dietrich" 2 => "A. Berger" 3 => "G. Bavinzski" 4 => "M. Weninger" 5 => "T. Czech" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Child's Nerv Syst" "fecha" => "2001" "volumen" => "17" "paginaInicial" => "663" "paginaFinal" => "669" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0295" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for infection and the effect of an institutional shunt protocol on the incidence of ventricular access device infections in preterm infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Riva-Cambrin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg Ped" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "156" "paginaFinal" => "160" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0300" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A.E. Radic" 1 => "M. Vincer" 2 => "P.D. McNeely" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg Ped" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "580" "paginaFinal" => "588" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0305" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cognitive and neurological outcome at the age of 5–8 years of preterm infants with post-hemorrhagic ventricular dilatation requiring neurosurgical intervention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.J. Brouwer" 1 => "C. Van Stam" 2 => "M. Uniken Venema" 3 => "C. Koopman" 4 => "F. Groenendaal" 5 => "L.S. De Vries" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000331797" "Revista" => array:6 [ "tituloSerie" => "Neonatology" "fecha" => "2012" "volumen" => "101" "paginaInicial" => "210" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22076409" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0310" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended experience with neuroendoscopic lavage for posthemorrhagic hydrocephalus in neonates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. d’Arcangues" 1 => "M. Schulz" 2 => "C. Bührer" 3 => "U. Thome" 4 => "M. Krause" 5 => "U.W. Thomale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.wneu.2018.04.169" "Revista" => array:6 [ "tituloSerie" => "World Neurosurg" "fecha" => "2018" "volumen" => "116" "paginaInicial" => "e217" "paginaFinal" => "e224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29729459" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/11301473/0000003400000003/v1_202305030948/S1130147322000252/v1_202305030948/en/main.assets" "Apartado" => array:4 [ "identificador" => "9727" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Investigación clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/11301473/0000003400000003/v1_202305030948/S1130147322000252/v1_202305030948/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147322000252?idApp=UINPBA00004B" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Enero | 1 | 0 | 1 |
| 2023 Mayo | 4 | 3 | 7 |
| 2023 Marzo | 2 | 4 | 6 |
| 2022 Junio | 2 | 1 | 3 |
