Prolonged puncturing decreases ventriculoperitoneal shunt insertion rate in neonates with posthemorrhagic ventricular dilatation.

PURPOSE: Posthemorrhagic ventricular dilatation (PHVD) is a frequent complication of intraventricular hemorrhage (IVH) in preterm infants and is associated with increased neurodevelopmental morbidity. Following national Dutch guidelines, infants with PHVD are generally punctured for up to 28 days via a ventricular access device (VAD), before a ventriculoperitoneal shunt (VPS) is inserted. We aimed to investigate retrospectively whether performing VAD punctures for longer than 28 days decreased the final VPS insertion rate.

METHODS

Retrospective single-center cohort study at the Erasmus MC-Sophia Children's hospital in Rotterdam, the Netherlands. Patients were included if they were born between 2010 and 2020 and treated for PHVD.

RESULTS

Out of 55 included patients, 23 were punctured in low frequency longer than 28 days via their VAD because of improved but persistent ventricular dilatation. Only 14 of them ultimately did require VPS insertion, resulting in a significant reduction of 15% in the final VPS insertion rate (p < 0.001).

CONCLUSION

Puncturing infants with PHVD with a beneficial clinical course via a VAD for longer than 28 days decreases the ventriculoperitoneal shunt insertion rate. Further research on prolonging temporizing punctures and its impact is warranted.