The Journal of pediatrics · 2026
Contemporary Surgical Management of Preterm Intraventricular Hemorrhage in North America.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Tamber Mandeep S, Jensen Hailey, Kestle John, Hydrocephalus Clinical Research Network
Аннотация
OBJECTIVE: To evaluate current surgical approaches to the management of preterm intraventricular hemorrhage (IVH) in North America.
STUDY DESIGN: This prospective North American observational cohort included 700 infants with preterm IVH who underwent neurosurgical evaluation. Patient characteristics were summarized at the time of initial consultation, the time of a temporizing and/or permanent cerebrospinal fluid (CSF) diversionary procedure, and the time of discharge from neurosurgical care.
RESULTS: Despite severe ventriculomegaly, a relative absence of signs of elevated intracranial pressure led to the initiation of an observational approach in 68% of the cohort. Surgical temporization occurred in 45%, generally prompted by the presence or emergence of signs of elevated intracranial pressure. Overall, permanent CSF diversion was required in 67%. Significant center variation in the proportion of infants undergoing temporary and permanent CSF diversion suggested heterogeneity in surgical decision making at these important timepoints.
CONCLUSIONS: Surgical temporization for preterm IVH was generally considered in the presence of signs of elevated intracranial pressure when ventricles are significantly dilated. Center-based heterogeneity in decision making at key timepoints represents an important opportunity for evidence-based standardization of care.
STUDY DESIGN: This prospective North American observational cohort included 700 infants with preterm IVH who underwent neurosurgical evaluation. Patient characteristics were summarized at the time of initial consultation, the time of a temporizing and/or permanent cerebrospinal fluid (CSF) diversionary procedure, and the time of discharge from neurosurgical care.
RESULTS: Despite severe ventriculomegaly, a relative absence of signs of elevated intracranial pressure led to the initiation of an observational approach in 68% of the cohort. Surgical temporization occurred in 45%, generally prompted by the presence or emergence of signs of elevated intracranial pressure. Overall, permanent CSF diversion was required in 67%. Significant center variation in the proportion of infants undergoing temporary and permanent CSF diversion suggested heterogeneity in surgical decision making at these important timepoints.
CONCLUSIONS: Surgical temporization for preterm IVH was generally considered in the presence of signs of elevated intracranial pressure when ventricles are significantly dilated. Center-based heterogeneity in decision making at key timepoints represents an important opportunity for evidence-based standardization of care.