Related Experiment Video
Updated: Jun 27, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a
Elizabeth Sewell1,2, Susan Cohen3, Isabella Zaniletti4
1Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA elizabeth.sewell@emory.edu.
Insights
Interventions for preterm infants with post-hemorrhagic hydrocephalus varied significantly by treatment center. Many infants requiring a temporizing device (TD) eventually needed a permanent shunt (PS), highlighting complex management needs.
Area of Science:
- Neonatal care
- Pediatric neurosurgery
- Clinical outcomes research
Background:
- Post-hemorrhagic hydrocephalus (PHH) is a serious complication in preterm infants.
- Management strategies for PHH vary, impacting infant outcomes.
- Understanding intervention patterns is crucial for optimizing care.
Purpose of the Study:
- To analyze the types and timing of interventions for PHH in preterm infants.
- To report short-term outcomes, including mortality and meningitis.
- To investigate variations in PHH management across different neonatal intensive care units (NICUs).
Main Methods:
- A cohort study using the Children's Hospitals Neonatal Database (2010-2022).
- Included preterm infants (<32 weeks gestation) with PHH.
- Analyzed interventions: no intervention, temporizing device (TD) only, permanent shunt (PS) only, or TD followed by PS (TD-PS).
Main Results:
- 3883 infants with PHH were analyzed from 41 NICUs.
- Intervention rates varied significantly by center (e.g., ventricular access device placement from 4% to 79%).
- 66% of infants with TDs ultimately required PS placement; overall mortality was 12%, and meningitis occurred in 11%.
Conclusions:
- Significant inter-center variation exists in PHH intervention rates.
- This variation may reflect differences in care practices or referral patterns.
- A substantial proportion of infants managed with TDs eventually required permanent shunts.
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%.
