Authors: Nolan Rea; Nolan Rea, BS; Jeffrey Quezada, BS; Peter Chiarelli; Jason Chu, MD, MSc; Mark Krieger, MD (Los Angeles, CA)

Introduction: The optimal timing of shunt placement in low birth weight infants remains unclear.  Earlier shunt placement may facilitate earlier patient discharges, and may mitigate the need for temporizing procedures.  However, it is commonly believed that early placement (at weight less than 2000g) may be associated with decreased rates of shunt survival. This study investigates shunt survival rates when shunts are placed in infants weighing less than 2000g, versus 2000-3000g. Methods: An IRB-approved retrospective analysis of 77 low birth-weight infants (29 females, 48 males) receiving shunt placement between January 2003 and October 2018 was performed. Shunt survival was compared between both weight groups, controlling for various other risk factors.  Results: Shunts were placed in 29 very low-weight (<2000g) infants and in 48 low-weight (2000-3000g) infants.   Etiologies for hydrocephalus were similar across the groups, and included hemorrhage (51%), spinal dysraphism (28%) predominantly. Mean gestational age was 31 weeks, and was again similar across groups. Sixteen patients (20%) had temporizing procedures, with a mean time between temporization and shunt placement of 48 days. 48% of shunts failed in the <2000g group as compared to 50% in the 2000-3000g group with mean follow-up of 52 months. A log-rank test comparing shunt survival rates yielded no significance (p=0.074). Conclusion: There was no significant difference in overall shunt survival between the two weight groups, suggesting no disadvantage to earlier shunt placement. Lower-weight shunting did show a trend toward earlier shunt revision. This study was limited by single-institution data and sample size.