Infection as a Complication of Intrathecal Baclofen Treatment in Children With Cerebral Palsy

TitleInfection as a Complication of Intrathecal Baclofen Treatment in Children With Cerebral Palsy
Publication TypeJournal Article
Year of Publication2016
AuthorsBayhan, I. A., Sees J. P., Nishnianidze T., Rogers K. J., & Miller F.
JournalJournal of pediatric orthopedics
Date Published2016 Apr-May
KeywordsAdolescent; Baclofen; Catheters; Cerebral Palsy; Child; Device Removal; Female; Humans; Incidence; Infection; Infusion Pumps, Implantable; Infusions, Spinal; Male; Muscle Relaxants, Central; Retrospective Studies; Risk Factors; Time Factors

BACKGROUND: Children with cerebral palsy (CP) and spasticity are often managed with intrathecal baclofen treatment (ITB). Complications of ITB include infection at the pump or catheter site and late complications as well as revisions of the pump and catheter because of events such as battery expiration or implant malfunction. The goal of this study is to report the short-term and long-term incidence, risk factors, and treatment outcomes of ITB infections in children.
METHODS: This was a retrospective review of 294 children with CP. The number of ITB surgeries per patient, risk of infection for primary and secondary ITB-related procedures, microorganisms responsible, and associated factors, such as concurrent orthopaedic interventions, medical comorbidities, and subsequent management of ITB-related infections, were evaluated.
RESULTS: Infection occurred in 28/294 patients (9.5%) with a 4.9% rate per procedure. There were 14 acute (within 90 d of surgery) and 14 late infections. The infection risk per ITB procedure was 2.4%. Risk of late infection over 5-year mean follow-up was 0.95% per year. Pump removal with acute contralateral implantation was the most successful treatment of infections. Gross Motor Function Classification System level V and G-tube were the main risk factors for infection. A total of 133 concurrent orthopaedic procedures were performed during 277 ITB procedures with no increased risk of infection.
CONCLUSIONS: ITB in children with CP has a relatively low and manageable risk of infection. It is important to always consider infection as a complication with ITB because with prompt treatment the positive impact of ITB is still possible. It is safe to perform concurrent orthopaedic procedures with ITB procedures.
LEVELS OF EVIDENCE: Level III-therapeutic study.

Alternate JournalJ Pediatr Orthop
Refereed DesignationRefereed