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Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study
  1. Elizabeth Sewell1,2,
  2. Susan Cohen3,
  3. Isabella Zaniletti4,
  4. Dan Couture5,
  5. Narendra Dereddy6,7,
  6. Carl H Coghill8,9,
  7. Tracy M Flanders10,
  8. Andrew Foy3,
  9. Gregory G Heuer10,
  10. Eni Jano11,
  11. Nicole Kemble10,
  12. Stephanie Lee12,
  13. Con Yee Ling13,14,
  14. Shadi Malaeb15,
  15. Ulrike Mietzsch16,
  16. Eylem Ocal17,
  17. Michael A Padula10,
  18. Cherrie D Welch18,
  19. Bernadette White19,
  20. Diane Wilson20,
  21. John Flibotte21
  22. on behalf of the Children’s Hospitals Neonatal Consortium Neurosurgery Focus Group
    1. 1 Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
    2. 2 Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
    3. 3 University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
    4. 4 The Children's Hospitals Neonatal Consortium, Dover, Delaware, USA
    5. 5 Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
    6. 6 AdventHealth for Children, Orlando, Florida, USA
    7. 7 University of Central Florida College of Medicine, Orlando, Florida, USA
    8. 8 Children's of Alabama, Birmingham, Alabama, USA
    9. 9 The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
    10. 10 The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
    11. 11 Children's Hospital Los Angeles, Los Angeles, California, USA
    12. 12 University of Iowa Health Care, Iowa City, Iowa, USA
    13. 13 The University of Utah School of Medicine, Salt Lake City, Utah, USA
    14. 14 Primary Children's Hospital, Salt Lake City, Utah, USA
    15. 15 Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
    16. 16 Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
    17. 17 University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
    18. 18 Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
    19. 19 Cook Children's Medical Center, Fort Worth, Texas, USA
    20. 20 Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
    21. 21 Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
    1. Correspondence to Dr Elizabeth Sewell, Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; elizabeth.sewell{at}emory.edu

    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%.

    • Neonatology
    • Neurosurgery
    • Neurology
    • Paediatrics

    Data availability statement

    No data are available.

    https://doi.org/10.1136/archdischild-2024-327084

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      Data availability statement

      No data are available.

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      Footnotes

      • Collaborators Beverly Brozanski, Jacquelyn Evans, Theresa Grover, Karna Murthy, Michael Padula, Eugenia Pallotto, Anthony Piazza, Kristina Reber and Billie Short and ex-officio David Durand, Francine Dykes, Jeanette Asselin are executive members of the Children’s Hospitals Neonatal Consortium, who developed and manage the CHND (thechnc.org). For more information, please contact: exec@thechnc.org.

      • Contributors ES made substantial contributions to the manuscript including conception and design, analysis and interpretation of the data, and drafting of the manuscript. IZ made substantial contributions to the manuscript including statistical analysis and interpretation of the data, as well as critical revision of the manuscript for important intellectual content. SC, DC, ND, CHC, TMF, AF, GGH, EJ, NK, SL, CYL, SM, UM, EO, MAP, CDW, BW and DW made substantial contributions to the manuscript including analysis and interpretation of the data, as well as critical revision of the manuscript for important intellectual content. JF made substantial contributions to the manuscript including conception and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, obtaining funding and supervision of the project.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • 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.

      • Provenance and peer review Not commissioned; externally peer reviewed.