Wide variation in death rates and post-hemorrhagic hydrocephalus (PHH) treatment in preterm severe intraventricular hemorrhage (IVH).

OBJECTIVE: Determine if decreased rates of severe IVH in VLBW infants in California translated to decreased rates of infant death or PHH treatment among those with severe IVH, and to evaluate variations in neurosurgical treatment of neonatal PHH. STUDY DESIGN: Retrospective observational cohort study of infants with severe IVH (grade III or IV) born at 220/7-316/7 weeks gestation with cranial imaging obtained within 28 days of birth and no congenital malformations. The primary outcome was a composite of PHH treatment or infant death. RESULT: Severe IVH rates declined in California with a concurrent decline in PHH treatment or infant death. Regional variability was observed in PHH treatment or infant death (range 38.0-55.9%, p < 0.0001) and the rates of utilizing a "shunt-first" PHH-treatment approach (range 25.5-81.5%, p < 0.0001). CONCLUSION: There is striking regional variation in the neurosurgical management of neonatal PHH and thus an urgent need to adopt standardized practices in IVH management.

Duke Scholars

Author Gerald Arthur Grant Neurosurgery