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

Elizabeth Sewell; Susan Cohen; Isabella Zaniletti; Dan Couture; Narendra Dereddy; Carl H Coghill; Tracy M Flanders; Andrew Foy; Gregory G Heuer; Eni Jano; Nicole Kemble; Stephanie Lee; Con Yee Ling; Shadi Malaeb; Ulrike Mietzsch; Eylem Ocal; Michael A Padula; Cherrie D Welch; Bernadette White; Diane Wilson; John Flibotte; Children’s Hospitals Neonatal Consortium Neurosurgery Focus Group

doi:10.1136/archdischild-2024-327084

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

Arch Dis Child Fetal Neonatal Ed. 2024 May 2:fetalneonatal-2024-327084. doi: 10.1136/archdischild-2024-327084. Online ahead of print.

Authors

Elizabeth Sewell^{1

2}, Susan Cohen³, Isabella Zaniletti⁴, Dan Couture⁵, Narendra Dereddy^{6

7}, Carl H Coghill^{8

9}, Tracy M Flanders¹⁰, Andrew Foy³, Gregory G Heuer¹⁰, Eni Jano¹¹, Nicole Kemble¹⁰, Stephanie Lee¹², Con Yee Ling^{13

14}, Shadi Malaeb¹⁵, Ulrike Mietzsch¹⁶, Eylem Ocal¹⁷, Michael A Padula¹⁰, Cherrie D Welch¹⁸, Bernadette White¹⁹, Diane Wilson²⁰, John Flibotte²¹; Children’s Hospitals Neonatal Consortium Neurosurgery Focus Group

Collaborators

Children’s Hospitals Neonatal Consortium Neurosurgery Focus Group:
Beverly Brozanski, Jacquelyn Evans, Theresa Grover, Karna Murthy, Michael Padula, Eugenia Pallotto, Anthony Piazza, Kristina Reber, Billie Short, David Durand, Francine Dykes, Jeanette Asselin

Affiliations

¹ Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA elizabeth.sewell@emory.edu.
² Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA.
³ University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA.
⁴ The Children's Hospitals Neonatal Consortium, Dover, Delaware, USA.
⁵ Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁶ AdventHealth for Children, Orlando, Florida, USA.
⁷ University of Central Florida College of Medicine, Orlando, Florida, USA.
⁸ Children's of Alabama, Birmingham, Alabama, USA.
⁹ The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.
¹⁰ The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹¹ Children's Hospital Los Angeles, Los Angeles, California, USA.
¹² University of Iowa Health Care, Iowa City, Iowa, USA.
¹³ The University of Utah School of Medicine, Salt Lake City, Utah, USA.
¹⁴ Primary Children's Hospital, Salt Lake City, Utah, USA.
¹⁵ Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
¹⁶ Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
¹⁷ University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
¹⁸ Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
¹⁹ Cook Children's Medical Center, Fort Worth, Texas, USA.
²⁰ Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
²¹ Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

PMID: 38697810
DOI: 10.1136/archdischild-2024-327084

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.