Post-hemorrhagic ventricular dilatation: Comparison of management pathways among North American level IV NICUs

OBJECTIVE: To assess the proportion of Level IV NICUs with post-hemorrhagic ventricular dilatation (PHVD) management pathways and compare the pathways. STUDY DESIGN: A survey was distributed to 49 Children's Hospitals Neonatal Consortium (CHNC) Level IV NICUs. A summarized pathway was developed from written pathways. RESULT: Survey response rate was 82%. Twelve (30%) NICUs have written pathways, 11 (28%) report informal consensus, and 17 (43%) lack consensus. Among the 12 written pathways, all serially monitor ventricular dilatation on cranial ultrasound (CUS) using ventricular index (58%) or frontal-occipital-horn-ratio (33%). Threshold for surgery varies: 33% of sites rely on CUS alone, while 67% incorporate clinical symptoms. Half of sites use lumbar puncture to decrease PHVD before surgery. Criteria for converting temporizing to permanent shunt is present in 67% of pathways. CONCLUSION: Amongst centers with written PHVD pathways, variable monitoring and intervention criteria exist. Most NICUs lack formal pathways, demonstrating opportunities to standardize care.