546 - Interventions and Short-term Outcomes for Preterm Infants with Post-hemorrhagic Hydrocephalus: A Multi-Center Cohort Study

Poster Number: 546
Publication Number: 546.1591

Background: Post-hemorrhagic hydrocephalus (PHH) is a significant cause of mortality, morbidity, and adverse neurologic outcomes in preterm infants. Surgical management of PHH remains variable and center-specific.

Objective: To (1) describe differences in the types and timing of interventions for PHH and (2) report short-term outcomes from a large national cohort of preterm infants with PHH.

Design/Methods: We queried the Children’s Hospitals Neonatal Database from 2010 to 2022 for all infants born before 32 weeks gestation with PHH defined as the diagnoses of acquired hydrocephalus and intraventricular hemorrhage; we excluded infants with selected neurologic or genetic anomalies. Surgical temporizing devices (TD) included ventricular access devices (VADs) and ventriculosubgaleal shunts (VSGS); permanent shunts (PS) included ventriculoperitoneal (VPS) and ventriculoatrial shunts. Infants were categorized based on intervention: (1) no surgical intervention, (2) TD only, (3) PS only, and (4) TD followed by PS (TD-PS). Selected short-term outcomes were presented using descriptive statistics.

Results: Our cohort included 3883 infants with PHH from 41 centers: 36% had no surgical intervention, 16% had a TD only, 18% had a PS only, and 30% had a TD-PS. Table 1 shows demographic characteristics. Of the 46% of infants with TDs, 75% were VADs and 25% were VSGS; 65% of infants with TDs required PS placement. Of the 50% of the cohort who had PS placed, VPS comprised 95%. Median chronologic and post-menstrual age at time of TD placement were similar between infants with only TD and those with TD-PS. Infants with TD-PS were older and larger than those with only PS at time of PS placement (Table 2). The proportion of intervention categories remained relatively constant over time, but there was variation in approach by center and gestational age. Outcomes are presented in Table 3. Death before NICU discharge occurred in 12% of the cohort and was most commonly due to withdrawal of life support. Mortality was highest in those with no surgical intervention and lowest for those with TD-PS. Meningitis occurred in 11% of the cohort and was lowest in those with no surgical intervention and highest for those with TD-PS. Approximately 1/3 of infants with PHH required tube feeds at discharge.

Conclusion(s): Surgical management varied substantively among this large contemporary cohort of infants with PHH. Rate of PS placement in infants with TDs was 65%. Mortality and meningitis varied by intervention group, which we plan to explore in future work.