School performance in children with infantile hydrocephalus: a nationwide cohort study

PURPOSE: Little is known about the prognosis for school performance among children with all-cause infantile hydrocephalus (IHC). Using detailed educational data, we investigated the school performance for IHC patients compared to other children in Denmark. PATIENTS AND METHODS: We conducted a population-based cohort study of all live-born children in Denmark (1977–2015) based on data from the Danish national health registers and the Danish educational register. The cumulative chance of completing school at age 18 years was estimated using the Aalen–Johansen estimator. The relative risks presented as ORs for not completing school, obtaining grades, or obtaining a grade point average below the national mean value were estimated using a logistic regression model. RESULTS: The cohort included 2,381,413 children, and of these, 2,573 were diagnosed with IHC. A total of 86% of IHC children completed compulsory school compared to 96% among other children; only 62% of IHC children who completed school received marks vs 96% among other children. Mediation analyses indicated that one-third of these poorer performances in IHC children could be attributable to their higher prevalence of epilepsy, spasticity, visual disturbances, autism, and attention-deficit hyperactivity disorder. Completion rates were similar for isolated and non-isolated hydrocephalus, and did not vary by age at diagnosis or number of surgeries. Of the children with isolated IHC, 73% obtained grades vs 58% of the children with non-isolated IHC. Poorer school performance in IHC children was also observed when considering age at school start, grade point average, and completion of further education. CONCLUSION: The poorer school performance among IHC children is particularly reflected by the larger proportion not obtaining grades compared to other children. However, the performance of the IHC children obtaining grades is comparable to that of other children.