title: Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage.
abstract: OBJECTIVE
  There is little consensus regarding the indications for surgical CSF diversion (either with implanted temporizing devices [reservoir or subgaleal shunt] or shunt alone) in preterm infants with posthemorrhagic hydrocephalus. The authors determined clinical and neuroimaging factors associated with the use of surgical CSF diversion among neonates with intraventricular hemorrhage (IVH), and describe variations in practice patterns across 4 large pediatric centers.
  
  
  METHODS
  The use of implanted temporizing devices and conversion to permanent shunts was examined in a consecutive sample of 110 neonates surgically treated for IVH related to prematurity from the 4 clinical centers of the Hydrocephalus Clinical Research Network (HCRN). Clinical, neuroimaging, and so-called processes of care factors were analyzed.
  
  
  RESULTS
  Seventy-three (66%) of the patients underwent temporization procedures, including 50 ventricular reservoir and 23 subgaleal shunt placements. Center (p < 0.001), increasing ventricular size (p = 0.04), and bradycardia (p = 0.07) were associated with the use of an implanted temporizing device, whereas apnea, occipitofrontal circumference (OFC), and fontanel assessments were not. Implanted temporizing devices were converted to permanent shunts in 65 (89%) of the 73 neonates. Only a full fontanel (p < 0.001) and increased ventricular size (p = 0.002) were associated with conversion of the temporizing devices to permanent shunts, whereas center, OFCs, and clot characteristics were not.
  
  
  CONCLUSIONS
  Considerable center variability exists in neurosurgical approaches to temporization of IVH in prematurity within the HCRN; however, variation between centers is not seen with permanent shunting. Increasing ventricular size-rather than classic clinical findings such as increasing OFCs-represents the threshold for either temporization or shunting of CSF.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA. Jay.Riva-Cambrin@hsc.utah.edu
authors.forename: Jay
authors.initials: J
authors.lastname: Riva-Cambrin
authors.forename: Chevis N
authors.initials: CN
authors.lastname: Shannon
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.forename: William E
authors.initials: WE
authors.lastname: Whitehead
authors.forename: Abhaya V
authors.initials: AV
authors.lastname: Kulkarni
authors.forename: James
authors.initials: J
authors.lastname: Drake
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Simon
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Browd
authors.forename: John R W
authors.initials: JR
authors.lastname: Kestle
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
mesh_terms: D000465:Algorithms; D001049:Apnea / Q000150:complications; D001919:Bradycardia / Q000150:complications; D001921:Brain / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000473:pathology / Q000601:surgery*; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D005865:Gestational Age; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology / Q000601:surgery*; D007231:Infant, Newborn; D007234:Infant, Premature; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome