Browsing by Author "Peter, Jonathan C"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Open Access
    Advantages of delayed ventriculoperitoneal shunting in post haemorrhagic hydrocephalus seen in low birth weight infants
    (1999) Taylor, Allan Grant; Peter, Jonathan C
    INTRODUCTION: The incidence of intraventricular hemorrhage (IVH) in very low birth weight infants is between 25 and 50%. Approximately 13-60% of these patients will develop progressive post hemorrhagic hydrocephalus (PHH) and of these 22- 70% will require CSF diversion. The most common therapeutic intervention is insertion of a ventriculoperitoneal shunt but there is considerable controversy surrounding the timing of the operation. Most authors promote early surgery to prevent secondary injury from hydrocephalus but it was our impression that this was associated with a higher incidence of shunt complications. METHOD: The incidence of shunt complications in 36 patients shunted for PHH were retrospectively reviewed. Patients were treated at Red Cross Children's Hospital over an 8 year period. RESULTS: Nine (25%) of the 36 patients required shunt revision for obstruction, seven required revision during the initial admission. Shunt infection occurred in 4 patients (11 %) all during the initial hospital admission. Four patients died, one from a shunt related complication. There was a clear relationship between the timing of surgery and the incidence of complications (chi square test p,0.01 ). Nineteen patients underwent surgery before 5 weeks of age and 9 developed early shunt complications. Of those shunted after 5 weeks none had an early complication. Groups were matched for weight and grade of IVH. DISCUSSION: A possible explanation for these results is that shunt complications are related to the quantity of blood present in the CSF at the time of shunting. A short delay before intervention is recommended in an effort to reduce the morbidity of shunt complications.
  • Thumbnail Image
    Item
    Open Access
    Decompressive craniectomy in children with traumatic brain injury
    (2005) Figaji, Anthony Aaron; Peter, Jonathan C; Fieggen, A Graham
    Although the conventional role of the operation was that of a salvage procedure when medical therapy failed in the treatment of raised intracranial pressure (ICP), two important concepts have emerged in the recent literature that appear to challenge that approach. In addition to the lack of evidence supporting benefit from current forms of treament, evidence from diverse studies that use data from magnetic resonance images, cerebral owygenation and cerebral blood flow measurements have highlighted potential adverse effects that may occur with these therapies.
  • Thumbnail Image
    Item
    Open Access
    Inhuman shields — children caught in the crossfire of domestic violence
    (2004) Fieggen, A Graham; Wiemann, Martin; Brown, Carla; Van As, Sebastian; Swingler, George; Peter, Jonathan C
    Background. Child abuse is a worldwide scourge. One of its most devastating manifestations is non-accidental head injury (NAHI). Methods. This is a retrospective chart review of children presenting to the Red Cross Children’s Hospital trauma unit with a diagnosis of NAHI over a 3-year period. Results. Sixty-eight children were included in the study and 2 different groups were identified. Fifty-three per cent of the children were deliberately injured (median age 2 years), while 47% were allegedly not the intended target of the assailant (median age 9 months). The assailant was male in 65% of the intentional assaults and male in 100% of the unintentional assaults, with the intended adult victim female in 85% of the latter cases. Overall, 85% of the assaults were committed in the child’s own home. Conclusions. The high proportion of cases in which a young child was injured unintentionally suggests that these infants effectively become shields in assaults committed by adults. In this context any attempts to deal with child abuse must also address the concurrent intimate partner violence.
  • Thumbnail Image
    Item
    Open Access
    The long-term sequelae of Selective Dorsal Rhizotomy in patients with Spastic Diplegia
    (2009) Langerak, Nelleke Gertrude; Vaughan, Christopher Leonard (Kit); Fiegen, A Graham; Peter, Jonathan C
    Includes abstract. Includes bibliographical references.
  • Thumbnail Image
    Item
    Open Access
    Multimodality monitoring in paediatric severe traumatic brain injury : the contributions of brain oxygen, transcranial doppler and autoregulation monitoring to conventional methods on monitoring
    (2008) Figaji, Anthony A; Peter, Jonathan C; LeRoux, Peter D
    Traumatic brain injury (TBI) is a highly complex clinical condition in the most complex organ of the body. The foundation of care of the patient with severe TBI is the prevention of secondary insults to the brain. This relies on conventional monitoring tools to identify patients at risk, but often these may fail to detect important secondary insults. Moreover, the therapies that are used commonly in the critical care environment all have potential adverse effects, many of which may not be evident. TBI treatment in children is further complicated by changing thresholds with age, and the much smaller evidence base compared to their adult counterparts.