Contemporary Surgical Management of Preterm Intraventricular Hemorrhage in North America.

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.