CONGENITAL PEDIATRIC HYDROCEPHALUS IN BRAZIL PUBLIC HEALTH SYSTEM: THE REALITY OF A MIDDLE-INCOME COUNTRY IN THE PAST 13 YEARS.

INTRODUCTION: Congenital hydrocephalus is a significant challenge in neurosurgery, particularly in resource-limited settings. This study focuses on the congenital hydrocephalus in Brazil, a developing country, over the past 13 years.

METHODS: This study is a retrospective analysis of congenital hydrocephalus treatment and outcomes using data records on DATASUS from January 2008 to July 2021. Demographics, cost of hospitalizations, amount paid to professionals, mortality rate, and mean length of stay (LOS) were analyzed. Statistical analysis was conducted to determine significant associations between these indicators and pediatric hydrocephalus.

RESULTS: DATASUS recorded 8,493 cases of congenital hydrocephalus in the studied period, with a prevalence of 24.28 per 100,000 newborns, mostly linked to spina bifida. Congenital hydrocephalus caused 60.83±13.98 neonatal deaths per year, with the highest rate among 32-36 weeks' gestational age. Acquired hydrocephalus led to 1,063 infant deaths, while congenital hydrocephalus resulted in 3,122 deaths, with no clear trend by the years. White infants had the highest mortality rates. It was performed 33,184 shunt procedures, with an average cost of $715.37 per procedure. The mortality rate model showed no significant effects of cost or professionals' salary, but a significant effect of LOS on hospitalization costs was observed.

CONCLUSION: Pediatric hydrocephalus in Brazil's public health system is a significant burden. Congenital hydrocephalus prevalence and mortality rates emphasize the need for early diagnosis and treatment. Early diagnosis, prenatal care, and adequate resources are crucial. This study offers insights into congenital hydrocephalus highlighting challenges and future directions for improved care.