OBJECTIVE: To assess the impact of extended continuous positive airway pressure (eCPAP) vs discontinued continuous positive airway pressure (dCPAP) on intermittent hypoxemia (IH) episodes, IH duration, and mean pulse oxi...OBJECTIVE: To assess the impact of extended continuous positive airway pressure (eCPAP) vs discontinued continuous positive airway pressure (dCPAP) on intermittent hypoxemia (IH) episodes, IH duration, and mean pulse oximeter oxygen saturation (SpO) in stable infants born preterm. STUDY DESIGN: Prespecified secondary analysis of a single-center randomized trial. Infants ≤32 weeks' gestation who required ≥24 hours of continuous positive airway pressure and met predefined respiratory stability criteria on room air at <35 weeks postmenstrual age were randomized to 14 days of eCPAP or dCPAP. Continuous pulse oximetry was obtained using a high-resolution research oximeter (2-second sampling rate). Analyses were by intention to treat. RESULTS: Ninety-five of 100 randomized infants were included (50 eCPAP, 45 dCPAP). Infants randomized to eCPAP experienced significantly fewer IH episodes (SpO <90% lasting 10-300 seconds) compared with dCPAP (mean 57.6 [SE 23.1] vs 151.7 [23.6]) for M of -94.1(19.2) episodes per 24 hours, 95% CI [-132.2, -55.9], P < .0001). eCPAP was associated with a higher mean SpO despite no supplemental oxygen use, fewer IH episodes across all thresholds and durations, and shorter cumulative IH duration. Functional residual capacity at the end of treatment was significantly higher in the eCPAP group and inversely correlated with IH burden (r = -0.32, P = .0016). Mediation analysis demonstrated that 66.3% of the treatment effect of eCPAP on IH reduction was mediated through increased SpO. CONCLUSIONS: In stable preterm infants breathing room air, extending continuous positive airway pressure therapy significantly reduces the frequency and duration of IH and increases mean oxygenation. eCPAP is a simple, nonpharmacologic strategy to mitigate IH during a critical period of lung and brain development. TRIAL REGISTRATION: ClinicalTrials.gov NCT04295564.
OBJECTIVE: To evaluate the language used to discuss a child's disability and understand themes related to its use. STUDY DESIGN: This descriptive qualitative study was embedded in a qualitative study examining family mee...OBJECTIVE: To evaluate the language used to discuss a child's disability and understand themes related to its use. STUDY DESIGN: This descriptive qualitative study was embedded in a qualitative study examining family meeting dynamics and decision-making in pediatric and neonatal intensive care units. Family meetings involved an infant 1 year old or younger and were held to discuss neurologic prognosis or goals of care. We performed a secondary, post hoc analysis of family meeting content to characterize language used to discuss current and/or future disability. RESULTS: A total of 68 family meetings were screened; 45 (66%) included disability language. Disability was referenced by explicitly naming disability, sharing information about disability characteristics, and using problematic language. We identified 5 themes that further characterized disability language: (1) euphemisms for disability, (2) invoking the healthy other, (3) the intersection between quality of life and disability, (4) using the medical model to contextualize disability, and (5) disability's impact on the child's family. CONCLUSIONS: The language used by family members and clinicians to discuss and contextualize disability provides important insight into how disability is addressed in pediatric and neonatal intensive care units. These findings emphasize the importance of including topics related to disability in medical education and can inform further work to develop training tools to aid pediatric clinicians in discussing disability effectively.
OBJECTIVE: To assess, in youth with type 1 diabetes (T1D), whether the initiation of early continuous glucose monitoring (CGM) with programmatic support to address sociodemographic barriers is associated with reduced dis...OBJECTIVE: To assess, in youth with type 1 diabetes (T1D), whether the initiation of early continuous glucose monitoring (CGM) with programmatic support to address sociodemographic barriers is associated with reduced disparities and improved glycemia. STUDY DESIGN: CGM was initiated <1 month postdiagnosis with remote monitoring and <7% glycosylated hemoglobin A1c (HbA1c) target in youth with new-onset T1D in the Teamwork, Targets, Technology, and Tight Glycemia program. We evaluated HbA1c stratified by race and ethnicity, insurance, deprivation, and language across 3 cohorts: historical (June 2014 to December 2016), pilot (July 2018 to June 2020), and study 1 (June 2020 to March 2022). RESULTS: At 12 months in study 1, HbA1c was lowest among non-Hispanic White (6.5%; 95% CI 6.2%-6.9%), low deprivation (6.5%; 95% CI 6.2%-6.9%), private insurance (6.6%; 95% CI 6.3%-7%), and English preference (6.7%; 95% CI 6.4%-7%). HbA1c disparities were attenuated in study 1: ethnicity slopes changed from historical (0.09; 95% CI -0.02 to 0.20) to pilot (0.14; 95% CI -0.04 to 0.31) to study 1 (0.08; 95% CI -0.07 to 0.23). Insurance slopes improved from historical (0.20; 95% CI 0.09-0.31) to pilot (0.12; 95% CI -0.06 to 0.29) to study 1 (0.01; 95%CI -0.14 to 0.16). Deprivation (41.3%) and race and ethnicity (32.2%) contributed most to HbA1c variability. CONCLUSIONS: Study 1 was associated with improved glycemic outcomes and attenuation of some disparities, particularly by insurance and ethnicity, supporting the Teamwork, Targets, Technology, and Tight Glycemia program as an effective equity-oriented care model. Deprivation emerged as a key model-derived contributor to variability in HbA1c and may represent an important target to reduce disparities in pediatric T1D glycemia.
OBJECTIVE: To evaluate national trends in admissions, length of stay (LOS), and charges for children with feeding difficulties. STUDY DESIGN: Serial, cross-sectional analysis using the Kids' Inpatient Database from 2009-...OBJECTIVE: To evaluate national trends in admissions, length of stay (LOS), and charges for children with feeding difficulties. STUDY DESIGN: Serial, cross-sectional analysis using the Kids' Inpatient Database from 2009-2022. Feeding difficulties were identified using diagnostic codes. Outcomes included the proportion of hospitalizations associated with feeding difficulties, LOS, and charges. Temporal trends and group effects were examined using multivariable logistic or linear regression adjusting for patient and hospital factors. RESULTS: Children with feeding difficulties accounted for an estimated 649 017 hospitalizations nationally, representing 4.89% of all hospitalizations (3.4% in 2009 vs 6.1% in 2022, P < .001). Mean LOS increased from 10.49 to 14.52 days and mean charges from $98,223 to $192,287; time was independently associated with both outcomes on multivariable regression (P < .001 for both). LOS and charges were approximately threefold higher in children with vs without feeding difficulties, and patient group was independently associated with both outcomes on multivariable regression (P < .001 for both). CONCLUSIONS: In children with feeding difficulties, LOS and charges increased over time and were significantly higher than in children without feeding difficulties. Future research should include efforts to reduce inpatient health care burden in this population.
Modi AC, Mara CA, O'Donnell H
… +12 more, Schmidt M, Kichler JC, Smith LB, Westen SC, Jacobsen L, Corathers SD, Williford DN, Trojanowski PJ, Flynn E, Shaffer ER, Tanner B, Driscoll KA
OBJECTIVE: To examine feasibility, acceptability, satisfaction, and preliminary efficacy of Diabetes Journey (DJ), a randomized controlled clinical trial for 12- to 17-year-old adolescents with type 1 diabetes (T1D). STU...OBJECTIVE: To examine feasibility, acceptability, satisfaction, and preliminary efficacy of Diabetes Journey (DJ), a randomized controlled clinical trial for 12- to 17-year-old adolescents with type 1 diabetes (T1D). STUDY DESIGN: Adolescents (n = 162; M = 14.8 ± 1.6 years; 56.4% female) who exceeded the clinical cut-point on the Barriers to Diabetes Adherence (BDA) questionnaire were randomized to DJ (amusement park-themed web modules) or enhanced standard of care (ESC; T1D education toolkit). Data were collected across 9 months, including baseline, posttreatment, follow-up 1 (3 months posttreatment), and follow-up 2 (6 months posttreatment). Primary outcomes were acceptability, feasibility, satisfaction, and BDA Stress/Burnout and Time Pressure/Planning scores at follow-up 1. Secondary outcomes were glycosylated hemoglobin A1c and quality of life. RESULTS: The group × time interaction was significant for the BDA Stress/Burnout subscale. Compared with ESC, the DJ group demonstrated a modest but statistically significant reduction in Stress/Burnout (b = -0.36, P < .05, 95% CI -0.72 to -0.01) and improvements in T1D quality of life (b = 7.09, P = .03, 95% CI 0.59-13.59). No significant differences occurred between groups for time pressure/planning. Adolescents and caregivers in DJ reported greater satisfaction than those in ESC. CONCLUSIONS: Our preliminary findings suggest that DJ had high acceptability, feasibility, and satisfaction. Adolescents randomized to DJ showed signals of reduced stress and burnout and improved quality of life at later follow-up, although these findings should be interpreted cautiously given attrition and the optional nature of the final follow-up assessment. TRIAL REGISTRATION: www. CLINICALTRIALS: gov NCT04404556.
Chadwick L, Emery CA, Madigan S
… +9 more, Brooks BL, Beauchamp MH, Craig W, Doan Q, Freedman SB, Gravel J, Zemek R, Yeates KO, Pediatric Emergency Research Canada (PERC) A-CAP Study Team
OBJECTIVE: To examine whether the setting in which children incur concussion occurs is associated with the trajectory of postconcussive symptoms (PCS). STUDY DESIGN: This substudy used data from the Advancing Concussion...OBJECTIVE: To examine whether the setting in which children incur concussion occurs is associated with the trajectory of postconcussive symptoms (PCS). STUDY DESIGN: This substudy used data from the Advancing Concussion Assessment in Pediatrics study, which involved a prospective cohort design. Participants aged 8-16 years with concussion (n = 529) or orthopedic injury (OI) (n = 265) were recruited during emergency department visits to 5 Pediatric Emergency Research Canada sites. The inclusion of an OI comparison group helps to differentiate concussion-specific effects from the general effects of injury on symptom reporting. Children rated their PCS at 1 week, 3 months, and 6 months postinjury using the Health and Behavior Inventory, a 20-item rating scale that yields cognitive and somatic symptom subscales. Linear multivariable multilevel modeling was used to examine the association of injury group (concussion vs OI) and injury setting (sport-related vs nonsport-related), and their interaction, with PCS over time. RESULTS: Children with concussion reported more severe cognitive and somatic PCS than those with OI at the postacute assessment regardless of injury setting. However, over time, injury setting moderated group differences in cognitive PCS, such that children who sustained concussions in nonsport-related settings reported significantly worse cognitive PCS than those with nonsport-related OI, but children with concussion and OI did not differ if injured in sport-related settings. At 6 months postinjury, group differences in cognitive symptoms remained significant and clinically meaningful for nonsport-related concussion (d = 1.26), but not for sport-related concussion (d = 0.09). In contrast, injury setting did not moderate group differences for somatic PCS. CONCLUSIONS: Cognitive but not somatic PCS are more pronounced and of longer duration when concussions are sustained in nonsport-related settings compared with sport-related settings. Further research is needed to determine why injury setting moderates concussion outcomes.
OBJECTIVES: To examine the association between maternal prepregnancy body weight status and newborn cord blood vitamin D concentrations and to explore the potential mechanism of maternal prenatal dietary factors and vita...OBJECTIVES: To examine the association between maternal prepregnancy body weight status and newborn cord blood vitamin D concentrations and to explore the potential mechanism of maternal prenatal dietary factors and vitamin D concentrations in this association. METHODS: Pregnant women were recruited from antenatal clinics in Hong Kong to assess risk factors on maternal prenatal and newborn cord blood vitamin D concentrations. Regression and path analyses were performed to explore the contribution of maternal factors before and during pregnancy to vitamin D concentrations in maternal prenatal blood and in newborn cord blood. RESULTS: Among 2726 mother-child dyads recruited, 9.94% of pregnant women and 82.91% of neonates were vitamin D insufficient. Insufficient total vitamin D intake and being overweight before pregnancy were risk factors for both maternal prenatal and newborn cord blood vitamin D insufficiency (aOR, 1.39-4.37; all P < .05). Path analyses showed that newborn cord blood vitamin D concentration was associated directly with maternal total vitamin D intake and indirectly with maternal prepregnancy body weight status via maternal prenatal vitamin D concentrations. CONCLUSIONS: Low vitamin D intake from diet and supplements was identified as a risk factor for vitamin D insufficiency in both pregnant women and their newborns. High prevalence of vitamin D insufficiency in neonates indicates the necessity of establishing clear guidelines to help pregnant women achieve their recommended daily vitamin D intake.
OBJECTIVE: To investigate associations of perinatal and lifestyle factors with alanine aminotransferase (ALT) levels as an early indicator of metabolic dysfunction-associated steatotic liver disease (MASLD). STUDY DESIGN...OBJECTIVE: To investigate associations of perinatal and lifestyle factors with alanine aminotransferase (ALT) levels as an early indicator of metabolic dysfunction-associated steatotic liver disease (MASLD). STUDY DESIGN: Data from the population-representative longitudinal physical activity and nutrition in children study, conducted among Finnish schoolchildren (n = 736), were utilized. Three visits during childhood included comprehensive assessments of metabolic biomarkers, body composition, and lifestyle factors. Perinatal data were obtained from registries and questionnaires. Altogether, 488 children were included in midchildhood (ages 7-8), 421 in late childhood (9-11), and 255 in adolescence (15-17). The predefined primary outcome was plasma ALT level, used as a biomarker of early-stage MASLD. RESULTS: In midchildhood and adolescence, significant associations (P < .05) between the children's ALT were detected for prepregnancy hypertension (β = 0.155-0.157). In late childhood, higher waist-to-height ratio and visceral adiposity by dual-energy X-ray absorptiometry became positively associated with ALT independent of body mass index SDS (β = 0.246-0.377). In adolescence, higher insulin levels and dyslipidemia (0.184-0.378) were positively associated with ALT. In late childhood, intake of protein and animal and dairy products (β = 0.121-0.184), and in adolescence, intake of protein and fish (β = 0.154-0.280), were positively associated with ALT, and intake of vegetables, fruit and berries, and fructose (β = -0.135 to -0.141) showed a negative association. In mid- and late childhood, levels of phenylalanine and branched-chain amino acids (β = 0.131-0.248), and in adolescence, those of omega-3/6 (β = -0.103 to 0.198) and all fatty acids (β = 0.197-0.228), were all positively associated with ALT. Sleep or measured physical activity were not associated with ALT. Several associations attenuated after multiple-testing correction for false discovery rate. CONCLUSIONS: Maternal hypertension, offspring intake of protein, animal and dairy products, levels of phenylalanine, branched-chain amino acids and fatty acids, and offspring cardiometabolic risk factors were associated with elevated ALT as an indicator of MASLD. The findings underscore the importance of pre- and postnatal influences and support early prevention, although caution is warranted as associations were modest and reduced after adjustment for false discovery rate. TRIAL REGISTRATION: ClinicalTrials.gov (ID number, NCT01803776; https://clinicaltrials.gov/study/NCT01803776).
OBJECTIVE: To evaluate the relationship between umbilical cord blood gases, postnatal blood gases, severity of clinical encephalopathy, and degree of injury on brain magnetic resonance imaging (MRI) in infants with hypox...OBJECTIVE: To evaluate the relationship between umbilical cord blood gases, postnatal blood gases, severity of clinical encephalopathy, and degree of injury on brain magnetic resonance imaging (MRI) in infants with hypoxic-ischemic encephalopathy. STUDY DESIGN: This was a retrospective cohort study of 168 infants treated for hypoxic-ischemic encephalopathy with therapeutic hypothermia. Information on demographics, clinical course, umbilical cord blood gases, and postnatal blood gases (capillary, venous, or arterial) were collected. Brain MRIs were blindly graded for severity using a systematic scoring system. RESULTS: The odds of moderate-to-severe brain injury on MRI increased by 45% with each 0.1 mmol/L decrease in postnatal pH (OR = 1.49, 95% CI: 1.02-2.16, P = .038), by 15% with each 1.0 mmol/L decrease in postnatal base deficit (BD) (OR = 1.19, 95% CI: 1.07-1.32, P = .002), and by 22% with each 1.0 mmol/L decrease in postnatal bicarbonate (OR = 1.22, 95% CI: 1.07-1.39, P = .003). Similar associations were observed between postnatal blood gas parameters and moderate-to-severe clinical encephalopathy on examination. Umbilical cord arterial and venous blood gas parameters were not associated with odds of either outcome, except for a nonlinear association with arterial pH in which further decreases among infants at already lower than average pH levels were associated with increased odds. In receiver operating characteristic analyses using postnatal gases, thresholds for predicting moderate-to-severe brain injury on MRI were BD ≤ -11.6 mmol/L and bicarbonate ≤ 13.2 mEq/L, with areas under the curve of 0.78 and 0.76, respectively. For moderate-to-severe clinical encephalopathy, the optimal threshold was BD ≤ -9.9 mmol/L (area under the curve of 0.71). CONCLUSIONS: Postnatal blood gas measurements obtained early after delivery are associated with increased odds of moderate-to-severe brain injury and clinical encephalopathy. Umbilical cord gas measurements did not demonstrate predictive power for neonatal outcomes.
Jackson WM, Foote HP, Stephenson N
… +27 more, Kemp SM, Moore RT, Nitkin CR, Stewart D, Pryhuber GS, Berger JT, Shukla A, England A, Ford SM, Parton LA, Check JF, Hanna MH, Lagoski M, Krishnan R, Leeman KT, Vyas-Read S, Hudak ML, Katheria AC, Pillers DM, Ji J, Banfro F, Nelin LD, McCulloch M, Ahmad K, Laughon MM, Hornik CP, SILDI-SAFE Study Group
OBJECTIVE: To describe the safety of sildenafil based on hypotension in premature infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN: We conducted a multicenter, randomized, double-blind, placebo-controlled, dos...OBJECTIVE: To describe the safety of sildenafil based on hypotension in premature infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN: We conducted a multicenter, randomized, double-blind, placebo-controlled, dose-escalating trial of sildenafil. Infants born < 29 weeks' gestation and at 32-44 weeks postmenstrual age with severe BPD were randomized sequentially into 3 cohorts to receive up to 34 days of intravenous or enteral sildenafil citrate vs placebo (3:1) in a dose-escalating approach. Safety was determined by the incidence of hypotension through 28 days following the last dose of study drug. Pulmonary hypertension by serial echocardiography and daily respiratory severity scores were obtained to assess preliminary efficacy. RESULTS: A total of 122 infants received sildenafil (N = 92) or placebo (N = 30). The incidence of hypotension did not differ between the sildenafil (1/92) and placebo (0/30) groups. Serious adverse events occurred in 8% of the sildenafil group and 13% of the placebo group; retinopathy of prematurity requiring treatment in 17% and 30%, abnormal hearing results in 8% and 7%, direct hyperbilirubinemia in 4% and 3%, alanine aminotransferase elevation in 3% and 0%, and escalation in respiratory support in 7% and 20%, respectively. There were no differences in daily respiratory severity scores between groups. CONCLUSIONS: Among premature infants with severe BPD, enteral sildenafil citrate did not increase the incidence of hypotension or retinopathy of prematurity. Although we found possible differences between groups in the development of BPD-associated pulmonary hypertension diagnosed by echocardiography in high-risk infants, a larger, randomized controlled trial is needed to assess efficacy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; Identifier: NCT04447989.
OBJECTIVE: To characterize patterns of antibiotic use among children with Crohn's disease and perianal fistulizing complications (PFCs) via a large, national administrative database. STUDY DESIGN: Retrospective analysis...OBJECTIVE: To characterize patterns of antibiotic use among children with Crohn's disease and perianal fistulizing complications (PFCs) via a large, national administrative database. STUDY DESIGN: Retrospective analysis of US administrative claims including patients ≤21 years with Crohn's disease diagnosed 2009-2018 and 5-years of continuous enrollment. We evaluated patient characteristics, medication dispensing, and disease outcomes. Multivariable negative binomial regression evaluated predictors of days of antibiotics dispensed. RESULTS: Five thousand two hundred seventy-seven patients were included, with median age 16.0 years at diagnosis (55% male, 77% commercial insurance, 61% White). In total 17% developed PFC during enrollment. Antibiotic dispensing was common, 83% had at least 1 antibiotic prescription. Patients with PFC had more antibiotic days (median 67 days, IQR 26-138) compared with those without PFC (median 27 days, IQR 10-63; P = .001). In an adjusted model, patients with PFC had 90% more antibiotic dispensing than those without PFC. CONCLUSIONS: PFCs are common and are associated with greatly increased antibiotic dispensing with 1 in 12 patients filling >20 prescriptions during the 4-year study period. The optimal use of antibiotics remains unclear, and their extensive use in this population emphasizes the need for evidence-based treatment strategies and approaches to antibiotic stewardship.
OBJECTIVE: To evaluate whether static ultrasound improves first-attempt, nontraumatic lumbar puncture (LP) success compared with the traditional landmark technique in infants admitted to a neonatal intensive care unit (N...OBJECTIVE: To evaluate whether static ultrasound improves first-attempt, nontraumatic lumbar puncture (LP) success compared with the traditional landmark technique in infants admitted to a neonatal intensive care unit (NICU). STUDY DESIGN: We conducted a prospective, randomized controlled trial at a single tertiary-care NICU between August 2016 and January 2020. Infants ≤6 months of age requiring LP were randomized 1:1 to ultrasound-assisted or traditional landmark LP. The primary outcome was first-attempt, nontraumatic LP success. Secondary outcomes included success within 2 attempts, procedure duration, and antibiotic exposure. Recruitment was terminated early due to the COVID-19 pandemic. RESULTS: We analyzed 95 LPs performed in 91 infants by 16 proceduralists. First-attempt nontraumatic success occurred in 50% of LPs in both groups (OR, 1.00; 95% CI, 0.41-2.43; P = 1.00). Other procedural success outcomes did not differ between groups. Procedure time was longer in the ultrasound group (mean 25.9 vs 17.9 minutes; P = .002). Median antibiotic duration was similar (8 days in both groups; P = .74). Ultrasound assistance improved success within 2 attempts among less experienced proceduralists, with diminishing benefit as LP experience increased. Operator ultrasound experience also modified effectiveness, with improved success observed among proceduralists with prior ultrasound exposure. CONCLUSIONS: Ultrasound assistance did not improve first-attempt nontraumatic LP success compared with the traditional landmark technique in NICU infants. Ultrasound assistance may improve success within 2 attempts among less experienced proceduralists, with effectiveness influenced by both LP and ultrasound experience. TRIAL REGISTRATION: ClinicalTrials.gov NCT02918149https://www. CLINICALTRIALS: gov/study/NCT02918149.
OBJECTIVE: To examine the demographic, clinical, and environmental characteristics of children with bronchopulmonary dysplasia (BPD) associated with respiratory readmissions. STUDY DESIGN: Demographic and clinical data w...OBJECTIVE: To examine the demographic, clinical, and environmental characteristics of children with bronchopulmonary dysplasia (BPD) associated with respiratory readmissions. STUDY DESIGN: Demographic and clinical data were obtained from children with BPD recruited from 15 centers participating in the BPD Collaborative between 2018 and 2025. Subjects with any hospital readmission for respiratory reasons were compared with children not readmitted as assessed by questionnaires obtained at clinic visits during the first 3 years of life. Clustered regression models were used to identify variables associated with readmission. Secondary analyses were performed to identify factors associated with a higher number (≥2) of readmissions. RESULTS: There were 1615 participants who met inclusion criteria with a mean age of 9.4 ± 7.5 months at recruitment. During the study period, 352 (21.8%) had at least 1 readmission and 1263 had no reported readmission. In multivariable models, an increased likelihood of readmission was associated with a shorter initial neonatal intensive care unit hospitalization, use of a home ventilator, prescription of reflux medications, daycare attendance, and lower BPD control score. CONCLUSIONS: In young children with BPD, markers of medical complexity, such as home ventilator use for chronic respiratory failure and gastroesophageal reflux, were associated with a high likelihood of respiratory readmissions. Other potentially modifiable factors associated with readmissions include daycare attendance and respiratory symptom control. BPD severity was not associated with readmission risk. Identifying risk factors for respiratory readmission in the outpatient setting will help healthcare providers to provide targeted anticipatory guidance.
OBJECTIVE: To evaluate current surgical approaches to the management of preterm intraventricular hemorrhage (IVH) in North America. STUDY DESIGN: This prospective North American observational cohort included 700 infants...OBJECTIVE: To evaluate current surgical approaches to the management of preterm intraventricular hemorrhage (IVH) in North America. STUDY DESIGN: This prospective North American observational cohort included 700 infants with preterm IVH who underwent neurosurgical evaluation. Patient characteristics were summarized at the time of initial consultation, the time of a temporizing and/or permanent cerebrospinal fluid (CSF) diversionary procedure, and the time of discharge from neurosurgical care. RESULTS: Despite severe ventriculomegaly, a relative absence of signs of elevated intracranial pressure led to the initiation of an observational approach in 68% of the cohort. Surgical temporization occurred in 45%, generally prompted by the presence or emergence of signs of elevated intracranial pressure. Overall, permanent CSF diversion was required in 67%. Significant center variation in the proportion of infants undergoing temporary and permanent CSF diversion suggested heterogeneity in surgical decision making at these important timepoints. CONCLUSIONS: Surgical temporization for preterm IVH was generally considered in the presence of signs of elevated intracranial pressure when ventricles are significantly dilated. Center-based heterogeneity in decision making at key timepoints represents an important opportunity for evidence-based standardization of care.