gms | German Medical Science

Objective: A number of sometimes controversial recommendations for the management of premature infants with post-haemorrhagic hydrocephalus (PHH) are found in the literature. In addition, neurosurgery and paediatric surgery departments in German hospitals use different methods to treat these patients. The objective of this study was to assess the current situation regarding the management of PHH, which is a first and essential step towards the development of standards of practice.

Methods: In the second half of 2009, we sent standardised questionnaires to 139 neurosurgery departments (number of returned questionnaires: 98) and 73 paediatric surgery departments (returned questionnaires: 63) in order to identify the principles of management of PHH. Paediatric patients with PHH are treated in 62 of the neurosurgery departments and in 20 of the paediatric surgery departments.

Results: Forty-three of the 62 neurosurgery departments and 17 of the 20 paediatric surgery departments providing care for paediatric patients with post-haemorrhagic hydrocephalus treat less than 10 children with PHH per year. Reservoir placement is the first step of treatment in 48 neurosurgery departments and in 15 paediatric surgery departments. The criteria underlying the placement of shunts and the implantation procedure are highly variable. Moreover, the percentage of children who receive initial treatment for PHH and then require a shunt ranges between 98% and 10%.

Conclusions: The type of treatment that infants with PHH receive in Germany differs from institution to institution. Clear and consistent guidelines must be established in an interdisciplinary approach in order to improve and better coordinate the management of infants with PHH.