6248 Recognition and management of neonatal intraventricular haemorrhages in the prevention of post-haemorrhagic ventricular dilatation

Objectives Post-Haemorrhagic Ventricular Dilatation (PHVD) is a potential complication of grade II-IV neonatal intraventricular haemorrhage (IVH).¹ This hampers neurodevelopmental development and, if PHVD progresses to hydrocephalus, it requires neurosurgical review and intervention.² Cranial ultrasound findings at diagnosis can be used to stratify IVH patients into risk categories for developing PHVD. The objective of this audit is to assess the Royal Cornwall Hospital (RCH) Neonatology Department's adherence to the management of PHVD according to the South West Neonatal Network (SWNN) 2023 guideline.² Methods A retrospective audit gathering data from Cranial Ultrasound Scans (CrUSS) booklets, Maxims, Badger Discharge Summaries and Cito eNotes between January 2022 until September 2023. Details collected included: occipitofrontal circumference (OFC), presenting neurological features, ventricular measurements, records of lumbar puncture interventions, neurosurgical referrals and IVH patient outcomes. PVHD risk categories were calculated according to the SWNN guideline.² Results In total, data from 17 patients was analysed. Of these, 7 were in the 'low risk' PVHD category; 6 in the moderate risk category; and 4 in the high risk category. 41.2% (n=7) of patients did not meet guideline recommendation for CrUSS monitoring for twice-weekly ultrasound scans up to 34/40 corrected gestational age (CGA). 8 patients required a lumbar puncture intervention, but only 1 patient received this. The 4 patients in the 'high risk' category required neurosurgical referral, but only 2 patients received this. By 34/40 CGA, 64.7% (n=11) patients had resolved or resolving IVH; 11.8% (n=2) had no change in IVH measurements; and 17.6% (n=3) had evidence of PVHD. 1 patient was lost to follow-up in a secondary unit. Conclusion RCH is not currently adhering to the SWNN guidelines for CrUSS monitoring in low risk PHVD; LP intervention in moderate risk PHVD; or neurosurgery referral in high risk PHVD. 52.9% (n=9) of patients did not have recorded CrUSS measurements so may have been inappropriately assigned to the 'low risk' category and some patients lacked birth OFC measurements. To ameliorate this, we suggest implementing a clear neonatal IVH proforma to record all required data in one place. Additionally, we suggest a teaching resource for neonatal staff involved in IVH care on the SWNN guidelines to ensure understanding of the management pathways and appropriate use of the proforma. References Weerakkody Y, Kearns C, Rasuli B, et al. Germinal matrix haemorrhage (grading). Radiopaedia.org, March 2023. Bristol, SW Neonatal ODN, Membership board, Post-haemorrhagic ventricular dilatation, south west neonatal network, 2023.