738 - Variability in the Management of Post-Haemorrhagic Ventricular Dilatation: An International Comparison Between iNeo Networks

Publication Number: 738.7080

Rocco Cuzzilla, The Royal Women's Hospital, Parkville, Victoria, Australia; Malcolm Battin, Auckland City Hospitial, Auckland, Auckland, New Zealand; Vieri Lastrucci, Meyer Children's hospital irccs, Firenze, Toscana, Italy; Rita C. Silveira, HCPA/UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; Gil Klinger, Schneider Children's Medical Center of Israel and Tel Aviv University, Ramat Hasharon, HaMerkaz, Israel; Mark Adams, University Hospital Zurich, Zurich, Zurich, Switzerland; Maximo Vento, Instituto de Investigación Sanitaria La Fe, VALENCIA, Comunidad Valenciana, Spain; Tetsuya Isayama, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Dirk Bassler, University Hospital of Zurich, Zurich, Zurich, Switzerland; Satoshi Kusuda, Neonatal Research Network of Japan, Taito, Tokyo, Japan; Laura San Feliciano, Hospital Universitario de Salamanca, Salamanca, Castilla y Leon, Spain; Neha Goswami, Mount Sinai Hospital, Toronto, ON, Canada; Mikael Norman, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden; Kjell Helenius, University of Turku, Turku, Varsinais-Suomi, Finland; Valerie Biran, Robert Debre Children's Hospital, Assistance Publique Hôpitaux de Paris,University Paris-Cité, INSERM U1141, France, Paris, Ile-de-France, France; Witold Błaż, Clinical Provincial Hospital No 2 University of Rzeszow, Poland, Rzeszów, Podkarpackie, Poland; Brian Reichman, Sheba Medical Center, Ramat Gan, HaMerkaz, Israel; Prakesh S. Shah, Mount Sinai Hospital, Toronto, ON, Canada; Kei Lui, University of New South Wales, Sydney, New South Wales, Australia

Background: The International Network for Evaluating Outcomes in Neonates (iNEO) has previously reported substantial variations of gestation age-specific grade III/IV intraventricular haemorrhage (IVH) among member networks, including that disparity widened as gestation decreased. Post-haemorrhagic ventricular dilatation (PHVD) is a serious complication of IVH and associated with high risk for mortality and adverse neurodevelopment. There is mounting evidence from pre-clinical and clinical studies to support improved neurodevelopmental outcomes with earlier drainage of cerebrospinal fluid (CSF). However, the optimal timing and interventions used to mitigate the risk for adverse neurodevelopment remain uncertain.

Objective: To survey the variations in PHVD management in preterm neonates of < 29 weeks’ gestation among neonatal units of 12 population-based national or regional neonatal networks participating in iNEO.

Design/Methods: Online pre-piloted questionnaires were sent to the directors or representatives of 608 NICUs participating in Australia/New Zealand (ANZNN, n=30), Brazil (BNN, n=20), Canada (CNN, n=32), Finland (FinMBR, n=5), France (FRA, n=70), Israel (INN, n=26), Japan (NRNJ, n=292), Poland (POL, n=56), Switzerland (SNN, n=9), Sweden (SNQ, n=9), Spain (SEN1500, n=55) and Tuscany, Italy (TuscanNN, n=4). The responses were based on practices in 2023. Two reminders were sent.

Results: Overall, 383 units (63%) responded, varying from 37 to 100% of units within participating networks. Australia/New Zealand, Canada, most European networks and Israel were more likely to initiate intervention for PHVD based on cranial ultrasound measures of ventricular size rather than clinical signs of raised intracranial pressure compared with Brazil, Finland and Japan (Fig 1). For those networks predominantly using cranial ultrasound to guide initiation of intervention, most units within those networks used higher rather than lower thresholds for ventricular size (Fig 1). Finland was more likely to refer infants with PHVD to the neurosurgeons for insertion of a ventriculo-peritoneal shunt when infants had clinical signs of raised intracranial pressure rather than when drainage of CSF failed to arrest ventricular dilation or decrease ventricular size compared with Australia/New Zealand, Canada, other European networks and Israel (Fig 2).

Conclusion(s): There were marked variations in PHVD management of very preterm infants within and across networks. Further collaboration and data exploration are needed to better understand the associations of these variations in practice.

Figure 1. Criteria for initiating intervention in infants with post-haemorrhagic ventricular dilatation


Figure 2: Referral to Neurosurgeons for insertion of a ventriculo-peritoneal shunt