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Survey of Quaternary Neonatal Management of Posthemorrhagic Hydrocephalus
Susan Cohen1, Ulrike Mietzsch2, Carl Coghill3
1Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin.
Insights
Clinical care for infants at risk for posthemorrhagic hydrocephalus (PHH) varies significantly across neonatal intensive care units (NICUs). Neonatologists and neurosurgeons often disagree on management, highlighting a need for standardized protocols.
Area of Science:
- Neonatal care
- Pediatric neurosurgery
- Clinical practice variation
Background:
- Posthemorrhagic hydrocephalus (PHH) is a significant concern in neonatal intensive care units (NICUs).
- Variability in clinical care practices can impact patient outcomes.
- Standardized management protocols are crucial for high-risk infant populations.
Purpose of the Study:
- To assess current clinical care practices for infants at risk of PHH in level IV NICUs.
- To identify variations in surveillance, neurosurgical intervention, and follow-up protocols.
- To evaluate the agreement between neonatologists and neurosurgeons on PHH management.
Main Methods:
- A cross-sectional survey was distributed to level IV NICUs within the Children's Hospitals Neonatal Consortium.
- The survey addressed center-specific practices for PHH surveillance, intervention, and follow-up.
- Response agreement was assessed using same-center pairs of neonatologists and neurosurgeons.
Main Results:
- A 59% response rate was achieved, with data from 20 sites.
- Most participants reported having a standard guideline for PHH (79%), yet 42% perceived management inconsistencies.
- Half of the neonatologist-neurosurgeon pairs disagreed on most care aspects, with high agreement on adopting a consensus protocol.
Conclusions:
- Significant practice variation exists in managing infants at risk for PHH across level IV NICUs.
- Despite perceived common practices, actual management strategies differ.
- There is a consensus on the willingness to adopt a standardized, evidence-based protocol for PHH care.
Objective:
This study aimed to determine clinical care practices for infants at risk for posthemorrhagic hydrocephalus (PHH) across level IV neonatal intensive care units (NICUs).
Study Design:
Cross-sectional survey that addressed center-specific surveillance, neurosurgical intervention, and follow-up practices within the Children's Hospitals Neonatal Consortium.
Results:
We had a 59% (20/34 sites) response rate, with 10 sites having at least two participants. Respondents included neonatologists (53%) and neurosurgeons (35%). Most participants stated having a standard guideline for PHH (79%). Despite this, 42% of respondents perceive inconsistencies in management. Eight same-center pairs of neonatologists and neurosurgeons were used to determine response agreement. Half of these pairs disagreed on nearly all aspects of care. The greatest agreement pertained to a willingness to adopt a consensus-based protocol.
Conclusion:
Practice variation in the management of infants at risk of PHH in level IV NICUs exists despite the perception that a common practice is available and used.
Key Points:
· Practice variation exists despite the perception that common practices are available/used for PHH.. · Our survey had same-center pairs of neonatologist and neurosurgeons to determine response agreement.. · The greatest agreement pertained to a willingness to adopt a consensus-based protocol..
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