Predictors of ventriculoperitoneal shunt among babies with intraventricular hemorrhage.

We aimed to identify medical care practices that influence the need for ventriculoperitoneal shunt among infants who develop intraventricular hemorrhage. We reviewed the medical records of 82 babies with ultrasonographically documented intraventricular hemorrhage. We compared the 10 babies who required a ventriculoperitoneal shunt to the 72 controls who had intraventricular hemorrhage, but did not require a ventriculoperitoneal shunt or die, prior to discharge. We considered maternal, perinatal, and neonatal risk factors as potential predictive variables. Maternal preeclampsia, prenatal steroids, and cesarean delivery were associated with a reduced risk of shunt. Patients who did require a shunt were more likely than their nonshunted peers to be treated with dopamine, to receive greater volumes of total intravenous fluid, largely as albumin and red blood cells, and to have a higher incidence of acidosis, patent ductus arteriosus and systolic hypertension. Previously identified antecedents and correlates of intraventricular hemorrhage appear also to be the antecedents and correlates of progression to ventriculoperitoneal shunt among infants with intraventricular hemorrhage. These findings are consistent with the possibility that prenatal and postnatal care practices influence the risk for ventriculoperitoneal shunt among babies with intraventricular hemorrhage. This offers the promise that changes in obstetric and neonatal care will reduce the need for ventriculoperitoneal shunt in very low birthweight infants.