Survey of Quaternary Neonatal Management of Posthemorrhagic Hydrocephalus

Objective  This study aimed to determine clinical care practices for infants at risk for posthemorrhagic hydrocephalus (PHH) across level IV neonatal intensive care units (NICUs). Study Design  Cross-sectional survey that addressed center-specific surveillance, neurosurgical intervention, and follow-up practices within the Children's Hospitals Neonatal Consortium. Results  We had a 59% (20/34 sites) response rate, with 10 sites having at least two participants. Respondents included neonatologists (53%) and neurosurgeons (35%). Most participants stated having a standard guideline for PHH (79%). Despite this, 42% of respondents perceive inconsistencies in management. Eight same-center pairs of neonatologists and neurosurgeons were used to determine response agreement. Half of these pairs disagreed on nearly all aspects of care. The greatest agreement pertained to a willingness to adopt a consensus-based protocol. Conclusion  Practice variation in the management of infants at risk of PHH in level IV NICUs exists despite the perception that a common practice is available and used. Key Points Practice variation exists despite the perception that common practices are available/used for PHH. Our survey had same-center pairs of neonatologist and neurosurgeons to determine response agreement. The greatest agreement pertained to a willingness to adopt a consensus-based protocol.