649 - Ventriculoperitoneal Shunt Placement in Preterm Infants with varying Severity of Intraventricular Hemorrhage

Publication Number: 2632.649

Emman Dabaja, Cleveland Clinic Children's, Cleveland, OH, United States; Nicole K. Buzalka, Cleveland Clinic Children's, Cleveland, OH, United States; Alshimaa Abdalla, Cleveland Clinic Children's, Cleveland, OH, United States; Allison Peluso, Cleveland Clinic Children's, Cleveland, OH, United States; HANY ALY, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Mohamed A. Mohamed, Cleveland, Cleveland, OH, United States

Background: Intraventricular hemorrhage (IVH) is a serious adverse outcome of prematurity. Post hemorrhagic ventricular dilation or hydrocephalus is one of the severe complications associated with higher grades (3 and 4) of IVH, which frequently requires surgical intervention with a temporarily reservoir or permanent shunt placement.

Objective: To examine the prevalence of ventriculoperitoneal shunt placement in preterm infants with varying severity of IVH.

Design/Methods: Using the National Inpatient Sample (NIS) datasets produced by the Healthcare Costs and Utilization Project (HCUP) from 2016 to 2020, we examined the prevalence and severity of IVH, occurrence of hydrocephalus in the overall sample and in infants <=34 weeks gestational age (GA) and infants born < 1500 grams. We compared the prevalence of shunt placement by IVH grade in each group using chi square tests and Cochran Armitage test for trend.

Results: The total sample size included 18,973,800 infants. Of them, 825,123 (4.35%) were <= 34 weeks GA, and 261,047 (1.38%) < 1500g birth weight (BW). About 209,683 (80.3%) of infants born < 1500g BW survived beyond 3 days of life with known IVH status. The prevalence of IVH was 0.45% in the overall sample, 8.4% in infants <=34wk, and 19% in infants born < 1500g.

The prevalence of hydrocephalus was relatively stable at 10% in the overall sample, with most occurring in infants with severe IVH (Table 1). About 20% of infants with grade 1 and 2 and about 33% of infants with grade 3 and 4 received shunt placement prior to discharge. The need for shunt placement steadily increased with severity of IVH, p = 0.01 (Table 2). Of note, about 15% of cases of shunt placement occurred in infants with no documented IVH, reflecting the prevalence of shunt placement in infants with hydrocephalus not associated with IVH.

Conclusion(s): Despite the high prevalence of IVH in infants < 1500g BW at 22.6%, only 10.5% of them developed hydrocephalus. The majority of hydrocephalus cases did not require shunt placement (only 31%).

Table 1: Intraventricular Hemorrhage, Hydrocephalus, and Shunt Placement in Newborn Infants


Table 2: Hydrocephalus and Shunt Placement by Grade of Intraventricular Hemorrhage in Infants <1500g birth weight