{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:25:12Z","timestamp":1787970312185,"version":"build-2784847793"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,19]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this study was to evaluate the clinical features and surgical complication rates of preterm infants with posthemorrhagic ventricular dilatation (PHVD) who underwent CSF diversion, comparing early intervention (EI) and late intervention (LI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This was a retrospective international multicenter study of infants born at \u2264 34 weeks\u2019 gestational age (GA) and treated between 2018 and 2022 for grade III or IV germinal matrix hemorrhage and intraventricular hemorrhage, who required intervention for PHVD. The primary outcome of interest was the rate of postoperative surgical complications. Secondary outcomes were rate of temporizing neurosurgical procedures (TNPs) after initial lumbar puncture (LP) if performed, rate of conversion from TNP to a ventriculoperitoneal shunt (VPS), and overall rate of VPS insertion. Summary statistics and univariable and multivariable logistic regression were performed to determine variables predictive of complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>One hundred seventy infants from 6 centers in the United States, Canada, and the Netherlands were included. Infants at LI centers were more premature (GA 26.7 \u00b1 2.8 vs 29.3 \u00b1 2.4 weeks, p &lt; 0.001) with lower birth weights (BWs; 1004 \u00b1 448 vs 1438 \u00b1 462 g, p &lt; 0.001) compared to those at EI centers. The first neurosurgical intervention occurred at a median day of life after birth (DOL) of 31.5 (IQR 24\u201345) days at LI centers versus 18 (IQR 13\u201321) days at EI centers (p &lt; 0.001). Ventricular index (&gt; 97th percentile) at the first neurosurgical intervention (TNP and\/or VPS placement) was lower at EI centers (5.05 \u00b1 2.32 vs 12.88 \u00b1 5.70 mm, p &lt; 0.001). Infant weight at the first neurosurgical intervention did not differ between site types (p = 0.466). EI centers had a larger proportion of patients who underwent LP (97% vs 58%, p &lt; 0.001) and smaller proportion who required a VPS after TNP (42% vs 70%, p = 0.002). The overall VPS insertion rate was higher at LI centers (62% vs 30%, p &lt; 0.001). There was no statistical difference in the complication rate between EI and LI centers (11% vs 24%, respectively, OR 0.42, 95% CI 0.12\u20131.24, p = 0.115). On univariable analysis, lower GA (p = 0.002), lower BW (p = 0.003), later DOL at first neurosurgical intervention (p = 0.035), diagnosis of meningitis before neurosurgical intervention (p = 0.047), and of necrotizing enterocolitis (p = 0.017) during the neonatal intensive care unit admission were predictive of complications. However, only lower GA (p = 0.029) and BW (p = 0.031) remained significant on multivariable analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The neurosurgical complication rate did not differ between EI and LI centers. On multivariable analysis, neurosurgical complications were associated with younger GA and lower BW but not with variables regarding the timing of intervention. These observations support cautious early CSF diversion in more preterm infants with lower BWs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.1.peds25486","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:22:36Z","timestamp":1781655756000},"page":"1-10","source":"Crossref","is-referenced-by-count":0,"title":["Surgical complications in early versus late intervention centers for progressive posthemorrhagic ventricular dilatation in preterm infants: a multicenter analysis"],"prefix":"10.3171","author":[{"given":"Grace Y.","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Nebraska, University of Nebraska Medical Center, Omaha, Nebraska"},{"name":"Department of Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niek E.","family":"van der Aa","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Woerdeman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"Deliloglu","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Division of Neonatology, The Hospital for Sick Children, University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet N.","family":"Cizmeci","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Division of Neonatology, The Hospital for Sick Children, University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Division of Neonatology, The Hospital for Sick Children, University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhaya V.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylke J.","family":"Steggerda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, Willem-Alexander Children\u2019s Hospital, Leiden University Medical Center, Leiden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radboud W.","family":"Koot","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandi","family":"Lam","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern University, Chicago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria L. V.","family":"Dizon","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalin","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Gano","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Francisco"},{"name":"Department of Neurology, University of California, San Francisco, California"},{"name":"Department of Pediatrics, University of British Columbia and BC Children\u2019s Hospital Research Institute, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David D.","family":"Limbrick","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda S.","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, Willem-Alexander Children\u2019s Hospital, Leiden University Medical Center, Leiden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Pediatr","first-page":"16","article-title":"Management of post-hemorrhagic ventricular dilatation in the infant born preterm","volume":"226","author":"El-Dib M","year":"2020","unstructured":"El-Dib M, Limbrick DD, Inder T,  Management of post-hemorrhagic ventricular dilatation in the infant born preterm. 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