Survey of Quaternary Neonatal Management of Posthemorrhagic Hydrocephalus

Susan Cohen; Ulrike Mietzsch; Carl Coghill; Narendra Dereddy; Katerina Ducis; Nathalie El Ters; Gregory G. Heuer; Elizabeth Sewell; John Flibotte; on behalf of the Children's Hospitals Neonatal Consortium (CHNC) Neurosurgery Focus Group

doi:10.1055/s-0041-1732417

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(08): 883-892
DOI: 10.1055/s-0041-1732417

Original Article

Survey of Quaternary Neonatal Management of Posthemorrhagic Hydrocephalus

Susan Cohen

¹Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin

,

Ulrike Mietzsch

²Division of Neonatology, Department of Pediatrics, University of Washington Medical School, Seattle Children's Hospital, Seattle, Washington

,

Carl Coghill

³Division of Neonatology, Department of Pediatrics, University of Alabama, Children's of Alabama, Birmingham, Alabama

,

Narendra Dereddy

⁴Division of Neonatology, Department of Pediatrics, University of Central Florida College of Medicine, AdventHealth for Children, Orlando, Florida

,

Katerina Ducis

⁵Division of Neurosurgery, Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont

,

Nathalie El Ters

⁶Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri

,

Gregory G. Heuer

⁷Division of Neurosurgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

,

Elizabeth Sewell

⁸Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta & Emory University School of Medicine, Atlanta, Georgia

,

John Flibotte

⁹Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

,

on behalf of the Children's Hospitals Neonatal Consortium (CHNC) Neurosurgery Focus Group

› Author Affiliations

Abstract

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.

Keywords

posthemorrhagic hydrocephalus - management - survey - Children's Hospitals Neonatal Consortium

Full Text

References

References
1 Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr 2012; 9 (03) 242-258
2 Christian EA, Jin DL, Attenello F. et al. Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000-2010. J Neurosurg Pediatr 2016; 17 (03) 260-269
3 Murphy BP, Inder TE, Rooks V. et al. Posthaemorrhagic ventricular dilatation in the premature infant: natural history and predictors of outcome. Arch Dis Child Fetal Neonatal Ed 2002; 87 (01) F37-F41
4 Alan N, Manjila S, Minich N. et al. Reduced ventricular shunt rate in very preterm infants with severe intraventricular hemorrhage: an institutional experience. J Neurosurg Pediatr 2012; 10 (05) 357-364
5 Cizmeci MN, Groenendaal F, Liem KD. et al. Randomized controlled early versus late ventricular intervention study (ELVIS) in posthemorrhagic ventricular dilatation: outcome at 2 Years. J Pediatr 2020
6 Mazzola CA, Choudhri AF, Auguste KI. et al; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr 2014; 14 (Suppl. 01) 8-23
7 American Academy of Pediatrics Committee on Fetus And Newborn. Levels of neonatal care. Pediatrics 2012; 130 (03) 587-597
8 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
9 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
10 Brouwer AJ, Brouwer MJ, Groenendaal F, Benders MJ, Whitelaw A, de Vries LS. European perspective on the diagnosis and treatment of posthaemorrhagic ventricular dilatation. Arch Dis Child Fetal Neonatal Ed 2012; 97 (01) F50-F55
11 Whittemore BA, Swift DM, Thomas JM, Chalak LF. A neonatal neuroNICU collaborative approach to neuromonitoring of posthemorrhagic ventricular dilation in preterm infants. Pediatr Res 2022; 91 (01) 27-34
12 Hand IL, Shellhaas RA, Milla SS. Committee on Fetus and Newborn, section On Neurology, Section on Radiology. Routine neuroimaging of the preterm brain. Pediatrics 2020; 146 (05) e2020029082
13 Ho T, Dukhovny D, Zupancic JA, Goldmann DA, Horbar JD, Pursley DM. Choosing wisely in newborn medicine: five opportunities to increase value. Pediatrics 2015; 136 (02) e482-e489
14 Antes S, Welsch M, Kiefer M, Gläser M, Körner H, Eymann R. The frontal and temporal horn ratio to assess dimension of paediatric hydrocephalus: a comparative volumetric study. Acta Neurochir Suppl (Wien) 2013; 118: 211-214
15 Kulkarni AV, Drake JM, Armstrong DC, Dirks PB. Measurement of ventricular size: reliability of the frontal and occipital horn ratio compared to subjective assessment. Pediatr Neurosurg 1999; 31 (02) 65-70
16 Levene MI. Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound. Arch Dis Child 1981; 56 (12) 900-904
17 de Vries LS, Groenendaal F, Liem KD. et al; ELVIS study group. Treatment thresholds for intervention in posthaemorrhagic ventricular dilation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2019; 104 (01) F70-F75
18 Riva-Cambrin J, Shannon CN, Holubkov R. et al; Hydrocephalus Clinical Research Network. Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage. J Neurosurg Pediatr 2012; 9 (05) 473-481
19 Wellons III JC, Shannon CN, Holubkov R. et al; Hydrocephalus Clinical Research Network. Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study. J Neurosurg Pediatr 2017; 20 (01) 19-29
20 Leijser LM, Miller SP, van Wezel-Meijler G. et al. Posthemorrhagic ventricular dilatation in preterm infants: when best to intervene?. Neurology 2018; 90 (08) e698-e706
21 Radic JA, Vincer M, McNeely PD. Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010. J Neurosurg Pediatr 2015; 15 (06) 580-588
22 Adams-Chapman I, Hansen NI, Stoll BJ, Higgins R. NICHD Research Network. Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion. Pediatrics 2008; 121 (05) e1167-e1177
23 El-Dib M, Limbrick Jr. DD, Inder T. et al. Management of post-hemorrhagic ventricular dilatation in the infant born preterm. J Pediatr 2020; 226: 16-27.e13
24 Flanders TM, Kimmel AC, Lang S-S. et al. Standardizing treatment of preterm infants with post-hemorrhagic hydrocephalus at a single institution with a multidisciplinary team. Childs Nerv Syst 2020; 36 (08) 1737-1744

Supplementary Material

Supplementary Material