Survey of Quaternary Neonatal Management of Posthemorrhagic Hydrocephalus

Cohen, Susan; Mietzsch, Ulrike; Coghill, Carl; Dereddy, Narendra; Ducis, Katerina; Ters, Nathalie El; Heuer, Gregory G.; Sewell, Elizabeth; Flibotte, John

doi:10.1055/s-0041-1732417

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Head circumference with or without clinical symptoms was frequently used for surveillance and often important for timing of intervention. Notably, we also found significant perceived intracentre differences in the approach to PHH management between neonatology and neurosurgical disciplines, even with a multidisciplinary standardised approach in place 29. This is a potential area for quality improvement in the CHNC network.…”

Section: Discussionmentioning

confidence: 75%

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Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study

Sewell,

Cohen,

Zaniletti

et al. 2024

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo (1) describe differences in types and timing of interventions, (2) report short-term outcomes and (3) describe differences among centres from a large national cohort of preterm infants with post-haemorrhagic hydrocephalus (PHH).DesignCohort study of the Children’s Hospitals Neonatal Database from 2010 to 2022.Setting41 referral neonatal intensive care units (NICUs) in North America.PatientsInfants born before 32 weeks’ gestation with PHH defined as acquired hydrocephalus with intraventricular haemorrhage.Interventions(1) No intervention, (2) temporising device (TD) only, (3) initial permanent shunt (PS) and (4) TD followed by PS (TD-PS).Main outcome measuresMortality and meningitis.ResultsOf 3883 infants with PHH from 41 centres, 36% had no surgical intervention, 16% had a TD only, 19% had a PS only and 30% had a TD-PS. Of the 46% of infants with TDs, 76% were reservoirs; 66% of infants with TDs required PS placement. The percent of infants with PHH receiving ventricular access device placement differed by centre, ranging from 4% to 79% (p<0.001). Median chronological and postmenstrual age at time of TD placement were similar between infants with only TD and those with TD-PS. Infants with TD-PS were older and larger than those with only PS at time of PS placement. Death before NICU discharge occurred in 12% of infants, usually due to redirection of care. Meningitis occurred in 11% of the cohort.ConclusionsThere was significant intercentre variation in rate of intervention, which may reflect variability in care or referral patterns. Rate of PS placement in infants with TDs was 66%.

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Section: Discussionmentioning

confidence: 75%

“…In our study, we found significant variation in the per cent of infants having VAD placement, which was the most common TD in our cohort. We previously reported approaches to surgical intervention for PHH in CHNC centres 29. While specific approaches vary by centre, some themes emerged.…”

Section: Discussionmentioning

confidence: 99%

Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study

Sewell,

Cohen,

Zaniletti

et al. 2024

Arch Dis Child Fetal Neonatal Ed

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Prediction of short- and long-term outcomes using pre-operative ventricular size in infants with post-hemorrhagic ventricular dilation

Serebin,

Zhang,

Yan

et al. 2024

Childs Nerv Syst

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Post-hemorrhagic ventricular dilation (PHVD) leads to developmental delays in premature infants, yet the optimal timing for neurosurgical interventions is unknown. Neuroimaging modalities have emerged to delineate injury and follow the progression of PHVD. Fronto-temporal horn ratio (FTHR) is used as a marker of ventricular dilation and can be a standardized tool to direct the timing of neurosurgical intervention. Our study determined the pre-operative FTHR measurement threshold to predict short-and long-term outcomes. MethodsThis is a retrospective cohort study of premature infants with severe intraventricular hemorrhage (IVH) treated in a level IV NICU that developed PHVD and required neurosurgical intervention between 2012 and 2019. A receiver operating characteristic (ROC) curve was performed to evaluate the pre-operative FTHR predictability for developmental delay. An area under the curve (AUC) measured the accuracy of FTHR. Inhospital outcomes and developmental assessments were analyzed. ResultsWe reviewed 121 charts of infants with IVH and identi ed 43 infants with PHVD who required neurosurgical intervention. We found FTHR measurements were an excellent measure of cognitive and motor delay with an AUC of 0.89 and 0.88, respectively. An average pre-operative FTHR of ≥ 0.67 was associated with worse lung and feeding outcomes. There was excellent inter-observer reliability of individual components of FTHR measurements. ConclusionsEarly intervention for PHVD is ideal but not always practical. Identifying ventricular size thresholds associated with better outcomes are needed to direct neurosurgical intervention timing.

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Spontaneous resolution of post-hemorrhagic ventricular dilatation in preterm newborns and neurodevelopment

et al. 2023

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Survey of Quaternary Neonatal Management of Posthemorrhagic Hydrocephalus

Cited by 3 publications

References 25 publications

Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study

Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study

Prediction of short- and long-term outcomes using pre-operative ventricular size in infants with post-hemorrhagic ventricular dilation

Spontaneous resolution of post-hemorrhagic ventricular dilatation in preterm newborns and neurodevelopment

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