Bedside external ventricular drainage in the NICU: procedural efficiency and infection trends in a 15-year single-center cohort.

PURPOSE: To compare the procedural efficiency of bedside versus operating-room external ventricular drainage (EVD) insertion in a neonatal intensive care unit (NICU) and to describe culture-positive EVD-associated infections. METHODS: We performed a retrospective single-center cohort study of NICU infants who underwent EVD insertion between 2011 and 2025. Operative time and insertion characteristics were analyzed at the insertion level. Culture-positive EVD-associated infections acquired at the study hospital were described, and annual infection incidence was explored in relation to unit methicillin-resistant Staphylococcus aureus (MRSA) acquisition rates. RESULTS: Sixty-six infants underwent 161 EVD insertions (115 bedside, 28 operating room, 18 outside hospital). Among 140 study-hospital insertions with documented operative time, bedside insertion was faster than operating-room insertion (24.5 (11.4) vs 57.4 (35.2) min; adjusted difference, 32.5 min; 95% CI, 16.7-48.4; p < 0.001). Seven study-hospital-acquired culture-positive EVD-associated infections occurred (2.37 per 1000 catheter-days at risk), all during bedside catheter episodes. Median time from catheter insertion to first positive culture was 2 days. In an exploratory annual ecological analysis, infection incidence correlated with NICU MRSA acquisition rates (Pearson r = 0.74; p = 0.009). CONCLUSION: Bedside NICU EVD insertion was substantially faster than operating-room insertion after adjustment for case-mix differences. Culture-positive infections occurred only during bedside catheter episodes; therefore, infection findings should be interpreted descriptively rather than as evidence of comparative infection safety.