Infection in Pediatric Ventriculo-Peritoneal Shunt: 40% of Shunts Fail Within the First 6 Months

This case involves a 6-month-old who was born prematurely and diagnosed with hydrocephalus at birth. A ventricular shunt was placed within the first week of life but several infections and malfunctions of the shunt ensued over the course of the baby’s first 6 months of life. The most severe complication of the obstructed shunt occurred when the child was placed in her crib and was unresponsive within 10 minutes of being left alone. The child had to be rushed to a major medical center and was subsequently revived but sustained severe neurological damage in the interim which was believed to be a hypoxic event linked to the mismanagement of the hydrocephalus.

Question(s) For Expert Witness

The main issues in the case are whether the physician negligently mismanaged the hydrocephalus and, if so, can the hypoxic event be linked to the hydrocephalus? Is it reasonable to argue that a 6 month old with severe hydrocephalus would have lack of head control to a degree where they would literally suffocate in a crib?

Expert Witness Response E-004688

Shunts are a frustrating procedure. The national average is that 40% of shunts fail within the first 6 months after they are placed and the national infection rate in a pediatric ventriculo-peritoneal shunt is close to 8%. Unless you have data that the CHoP experience is vastly different, the case you describe, while sad, is frustratingly common. 1/3 shunted patients develop epilepsy. A more likely scenario (from what you describe) is they had a seizure that led to the hypoxic episode. You don’t comment on how developmentally delayed the patient was prior to the hypoxic incident but most of these kids are very affected neurologically, meaning they have poor muscle control, the hydrocephalus makes them macrocephalic (big head) so you have a large pendulum on a floppy stick.