Volume 7 Supplement 1

54th Annual Meeting of the Society for Research into Hydrocephalus and Spina Bifida

Open Access

Ventricular lavage for post-haemorrhagic hydrocephalus

Cerebrospinal Fluid Research20107(Suppl 1):S49

https://doi.org/10.1186/1743-8454-7-S1-S49

Published: 15 December 2010

Background

Early results of an international RCT comparing drainage, irrigation &fibrinolytic therapy (DRIFT)for prematurity-associated post-ventricular dilatation (PHVD), with standard treatment suggested no benefit in terms of avoidance of shunt dependency. There was also an increased rate of secondary bleeds in those having DRIFT. The longer term benefits or otherwise of DRIFT treatment were unknown.

Materials and methods

We randomly allocated 77 preterm infants with PHVD to either DRIFT or standard treatment (ie tapping off cerebrospinal fluid to control excessive ventricular expansion). Severe disability was assessed at 2 years’ corrected age.

Results

Of 39 infants assigned to DRIFT, 21 (54%) died or were severely disabled versus 27 of 38 (71%) in the standard group (adjusted odds ratio 0.25 [95% confidence interval: 0.08–0.82]). Among the survivors, 11 of 35 (31%) in the DRIFT group had severe cognitive disability versus 19 of 32 (59%) in the standard group (adjusted odds ratio: 0.17 [95% confidence interval: 0.05– 0.57]). Median Mental Development Index was 68 with DRIFT and_50 with standard care.

Conclusions

Despite inducing an increased rate of secondary intraventricular bleeding, DRIFT reduced severe cognitive disability in survivors and overall rates of death or severe disability. A modification of DRIFT involving simple ventricular lavage and fibrinolytic therapy (limited to unblocking clogged-up drainage catheters) will now be employed in clinical practice at our unit.

Authors’ Affiliations

(1)
Department of Neurosurgery, Frenchay Hospital
(2)
Department of Neonatal Medicine, Southmead Hospital

Copyright

© Pople and Whitelaw; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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