Brain growth and neurodevelopment after surgical treatment of infant post-infectious hydrocephalus in sub-Saharan Africa
Bibliographic record
Abstract
ABSTRACT Importance Post-infectious hydrocephalus in infants is a major public health burden in sub-Saharan Africa. Objective To determine long-term brain growth and cognitive outcome after surgical treatment of infant post-infectious hydrocephalus in Uganda. Design Prospective follow-up of a previously randomized cohort. Setting Single center in Mbale, Uganda. Participants Infants (<180 days old) with post-infectious hydrocephalus. Interventions Endoscopic or shunt surgery. Main outcomes Bayley Scales of Infant Development (BSID-3) and brain volume on computed tomography (raw and normalized for age and sex) at 2 years after treatment. Results Eighty-nine infants were assessed for 2-year outcome. There were no significant differences between the two surgical treatment arms, so they were analyzed together. Raw brain volumes increased between baseline and 24 months (median change=361 cc, IQR=293 to 443, p<0.001), but almost all of this increase was seen in the first year (median change=381 cc, IQR=310 to 442, p<0.001), with very little change between 12 and 24 months (median change=-5 cc, IQR=-52 to 42, p=0.66). The fraction of those with a normal brain volume increased from 15% at baseline to 50% at 1 year, but then declined to 18% at 2 years. Substantial normalized brain volume loss was seen in 21% between baseline and year 2 and in 77% between years 1 and 2. The extent of brain growth in the first year was not associated with extent of brain volume changes in the second year. There were significant positive correlations between 2-year brain volume and all BSID-3 scores and BSID-3 changes from baseline. Conclusions and Relevance In sub-Saharan Africa, even after successful surgical treatment of infant post-infectious hydrocephalus, post-treatment brain growth stagnates in the second year. While the reasons for this are unclear, this emphasizes the importance of primary infection prevention strategies along with optimizing the child’s environment to maximize brain growth potential. Trial Registration ClinicalTrials.gov number, NCT01936272 KEY POINTS Question What is the brain growth and cognitive trajectory of infants treated for post-infectious hydrocephalus in Uganda? Findings In this prospective follow-up of a cohort of 89 infants, early normalization of brain volume after treatment was followed by brain growth stagnation in the second year, with many falling back into the sub-normal range. Poor brain growth was associated with poor cognitive outcome. Meaning Successful surgical treatment of hydrocephalus is not sufficient to allow for adequate brain growth and cognitive development. Interventions aimed at primary infection prevention and reducing comorbidities are needed to improve brain growth potential.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".