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.