Five-year outcomes after surgical treatment of infant postinfectious hydrocephalus in sub-Saharan Africa: results of a randomized trial
Bibliographic record
Abstract
OBJECTIVE: Postinfectious hydrocephalus (PIH) in infants is a major public health burden in sub-Saharan Africa. In a previously reported randomized trial, the authors found no significant differences in outcome between endoscopic versus shunt treatment, with stagnation in brain growth at 2 years after treatment. They now present the 5-year follow-up results of this cohort, assessing detailed developmental, quality of life, and brain volume outcomes. METHODS: The authors performed a trial at a single center in Mbale, Uganda, involving 100 infants (< 180 days of age) with PIH randomized to endoscopic third ventriculostomy plus choroid plexus cauterization (ETV/CPC) or ventriculoperitoneal shunt (VPS) treatment. After 5 years, they assessed developmental outcomes with the Vineland Adaptive Behavior Scales, Third Edition (VABS-3), quality of life with the Health Utilities Index Mark 3 (HUI-3) and Hydrocephalus Outcome Questionnaire (HOQ), and brain volume derived from CT scans. RESULTS: Sixty-three infants were assessed for 5-year outcomes (35 ETV/CPC and 28 VPS, by intention to treat). There were no significant differences between the two surgical treatment arms in treatment failure (p = 0.39), VABS-3 scores (p > 0.52), HUI-3 utility scores (p > 0.37), HOQ scores (p > 0.18), or brain volume (raw p = 1.0, adjusted p = 0.24). There were strong correlations between VABS-3, HUI-3, and HOQ scores with brain volume adjusted for age and sex, and weaker correlations when adjusted for anthropometric measurements. CONCLUSIONS: These results suggest that ETV/CPC and VPS treatment have comparable long-term outcomes for infants in medically resource-constrained environments. Furthermore, brain volume strongly correlates with developmental and quality of life metrics, emphasizing the need to focus on optimizing brain volume growth potential in infants with severe perinatal neurological insults such as infection and hydrocephalus.
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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 | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".