Post Hemorrhagic Hydrocephalus Management Among NICUs and Associated Comorbidities and Complications

Background: Post-hemorrhagic hydrocephalus (PHH) remains a major morbidity of premature birth resulting from intraventricular hemorrhage (IVH). National consensus guidelines to direct timing of surgical interventions are lacking, and leads to considerable variation in management among NICUs. Early intervention has been shown to improve outcomes, but we hypothesized that timing to intervene affects the comorbidities and complications associated with PHH. Objective: To characterize comorbidities and complications associated with PHH management in a large national inpatient care dataset. Methods: We conducted a retrospective cohort study of hospital discharge data for premature infants (28 days). Hospital stay data included hospital region, gestational age (GA), birth weight (BW), length of stay (LOS), PHH treatment procedures, comorbidities, surgical complications, and death. Statistical analysis included Chi-square, Fisher exact, and Poisson or logistic regression. Analysis was adjusted for demographics, comorbidities and complications. Results: Of the 1394 infants diagnosed with PHH, 357 (25%) had documented timing of surgical interventions during their hospital stay. More infants had LI compared to EI (76.4%). LI group infants were younger GA, lower BW, and more likely on public insurance. There was a regional difference in timing of treatment: hospitals in the West performed EI, whereas hospitals in the Midwest performed LI (Table 1). The LI group was associated with longer median (25th - 95th Percentile) LOS compared to the EI group [107 (87 - 134) vs. 77 (59 - 98) days). More temporary CSF diversion procedures occurred in the EI group, whereas more permanent CSF-diverting shunts were placed in the LI group. In those infants who required conversion to shunts in the EI group, replacement occurred earlier in the EI group than the LI group [median (25th - 75th Percentile) 74 (50 - 93) vs 84 (59 - 120) days]. Shunt/device removal and complications did not differ between the two groups. The LI group had 3-fold higher odds of sepsis (p<0.01) and a ¼ -fold lower odds of death (p<0.05) compared to the EI group (Table 2). Conclusion: Timing of PHH intervention has regional differences suggesting the importance of national consensus guidelines. Development of these guidelines can be informed by the results of large national datasets which provide insights to comorbidities and complications of PHH interventions.