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Post-hemorrhagic ventricular dilatation: Comparison of management pathways among North American level IV NICUs
Journal article   Open access   Peer reviewed

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

Kristen Coletti, Stephanie S Lee, Susan Cohen, Maria L V Dizon, David S Hersh, Ulrike Mietzsch, Eylem Ocal, Elizabeth K Sewell and Children’s Hospitals Neonatal Consortium (CHNC) Neurosurgery Focus Group
Journal of perinatology
02/23/2026
DOI: 10.1038/s41372-026-02595-z
PMID: 41731041
url
https://doi.org/10.1038/s41372-026-02595-zView
Published (Version of record) Open Access

Abstract

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

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