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Long-term effects of drainage, irrigation and fibrinolytic therapy for preterm infants with post-hemorrhagic ventricular dilatation

Presented at the Neonatal Society 2009 Summer Meeting (programme).

Whitelaw A1, Jary S1, Kmita G2, Wroblewska J3, Swietlinska E3, Mandera M3, Hunt L1, Carter M4, Pople I4

1 Department of Clinical Science, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
2 Faculty of Psychology, University of Warsaw, Warsaw, Poland
3 Departments of Neonatal Intensive Care and Neurosurgery, Medical University of Silesia, Katowice, Poland
4 Department of Neurosurgery, Frenchay Hospital, Bristol, UK

Background: Preterm infants who develop post-hemorrhagic ventricular dilatation (PHVD) have a high risk of cognitive and motor disability. No clinical intervention has been proven to reduce neurodevelopmental disability in such infants. We investigated whether Drainage, Irrigation and Fibrinolytic Therapy (DRIFT) (1) reduces severe disability in PHVD.

Methods: We randomly assigned 77 preterm infants with PHVD to either DRIFT or standard treatment i.e. tapping off cerebrospinal fluid (CSF) to control excessive expansion. Neurodevelopmental assessment and the Bayley Scales of Infant Development II were carried out at 2 yr corrected age.

Results: Of 39 infants assigned to DRIFT, 19 (49%) died or were severely sensorimotor disabled v 23 of 38 (61%) in the standard group (odds ratio 0.62 95% confidence interval (CI) 0.25 to 1.53). 11 of 35 survivors (31%) in the DRIFT group had severe cognitive disability (Mental Development Index <55) v 19 of 32 survivors (58%) in the standard group (odds ratio 0.32 CI 0.12 to 0.86). Median MDI was 68 with DRIFT, and <50 with standard care. Gait, sitting, hand control, head control, speech, hearing, vision and epilepsy all showed trends in favor of DRIFT but were not statistically significant.

Conclusion: DRIFT did not significantly reduce death or severe sensorimotor disability. Severe cognitive disability was significantly reduced. Motor disability from periventricular infarction may not improve but the reduction in pressure, distortion, free iron and cytokines with DRIFT may reduce secondary cerebral injury and protect cognitive development. This is the first intervention shown to improve outcome in PHVD. (ISRCTN 80286058).

1. Whitelaw A et al. Pediatrics. 2003;111:759-65.

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