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Multicenter Study
. 2024 Dec 20;110(1):10-16.
doi: 10.1136/archdischild-2024-327084.

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

Elizabeth Sewell  1   2 , Susan Cohen  3 , Isabella Zaniletti  4 , Dan Couture  5 , Narendra Dereddy  6   7 , Carl H Coghill  8   9 , Tracy M Flanders  10 , Andrew Foy  3 , Gregory G Heuer  10 , Eni Jano  11 , Nicole Kemble  10 , Stephanie Lee  12 , Con Yee Ling  13   14 , Shadi Malaeb  15 , Ulrike Mietzsch  16 , Eylem Ocal  17 , Michael A Padula  10 , Cherrie D Welch  18 , Bernadette White  19 , Diane Wilson  20 , John Flibotte  21 ; Children’s Hospitals Neonatal Consortium Neurosurgery Focus Group
Collaborators, Affiliations
Multicenter Study

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

Elizabeth Sewell et al. Arch Dis Child Fetal Neonatal Ed. .

Abstract

Objective: To (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).

Design: Cohort study of the Children's Hospitals Neonatal Database from 2010 to 2022.

Setting: 41 referral neonatal intensive care units (NICUs) in North America.

Patients: Infants 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 measures: Mortality and meningitis.

Results: Of 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.

Conclusions: There 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%.

Keywords: Neonatology; Neurology; Neurosurgery; Paediatrics.

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Conflict of interest statement

Competing interests: ES has received consultant fees from Hospicom on topics unrelated to the subject of this manuscript. UM serves as an advisor for Hope for HIE in an unpaid role, unrelated to the subject of this manuscript. EO is an executive board member of International Society of Pediatric Neurosurgery, which is an unpaid role distinct from this manuscript. MAP has received consultant fees from Chiesi on topics unrelated to the subject of this manuscript. JF consults as an expert reviewer for White & Williams, Cipriani & Werner and Janssen Global Services on topics unrelated to the subject of this manuscript.

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