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Objective <p>To assess the proportion of Level IV NICUs with post-hemorrhagic ventricular dilatation (PHVD) management pathways and compare the pathways.</p> Study design <p>A survey was distributed to 49 Children’s Hospitals Neonatal Consortium (CHNC) Level IV NICUs. A summarized pathway was developed from written pathways.</p> Result <p>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.</p> Conclusion <p>Amongst centers with written PHVD pathways, variable monitoring and intervention criteria exist. Most NICUs lack formal pathways, demonstrating opportunities to standardize care.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月23日

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  • Kristen Coletti,
  • Stephanie S. Lee,
  • Susan Cohen,
  • Maria L. V. Dizon,
  • David S. Hersh,
  • Ulrike Mietzsch,
  • Eylem Ocal,
  • Elizabeth K. Sewell

摘要

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.