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Efficacy and safety of intraventricular fibrinolytic therapy for post-intraventricular hemorrhagic hydrocephalus in extreme low birth weight infants: a preliminary clinical study

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Abstract

Purpose

To evaluate the efficacy and safety of our unique therapy for treating post-intraventricular hemorrhagic hydrocephalus (PIVHH) in low birth weight infants (LBWls) through an early stage fibrinolytic therapeutic strategy involving urokinase (UK) injection into the lateral ventricle, called the “Ventricular Lavage (VL) therapy.”

Methods

Overall, 43 consecutive infants with PIVHH were included. Most were extremely LBWIs (n = 39). Other cases included very LBWIs (n = 2) and full-term infants (n = 2). VL therapy involved continuous external ventricular drainage (EVD) management using a very fine catheter and intermittent slow injection of 6000 IU of UK every 3–6 h to actively dissolve hematomas.

Results

Early EVD management (within 3 weeks of IVH onset) was performed in 25 infants, with combination VL therapy in 21 infants. Five initiated late EVD management (≥ 3 weeks after IVH onset); the remaining 13 were treated conservatively for several weeks, delaying surgical intervention. Eighteen of 21 (86%) infants who received VL therapy did not require permanent shunt surgery. There were no serious complications, including the absence of secondary hemorrhage and infection. Two-thirds of the infants treated in the late stages required permanent shunt, and various shunt-related complications frequently occurred. A good outcome occurred in 13/17 infants in the early treatment group, despite most subjects having an IVH grade IV, and in 6/15 in the late treatment group.

Conclusions

Permanent shunt surgery needs were dramatically reduced following early VL therapy, and functional outcomes were favorable. VL therapy might be a promising strategy that could lead to the development of new treatments for PIVHH.

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Authors and Affiliations

  1. Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan

    Young-Soo Park, Yukiko Kotani, Tae Kyun Kim, Hiroshi Yokota, Tadashi Sugimoto, Ichiro Nakagawa, Yasushi Motoyama & Hiroyuki Nakase

  2. Division of Neurosurgery, Children’s Medical Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, Japan

    Young-Soo Park

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  1. Young-Soo Park
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  2. Yukiko Kotani
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  3. Tae Kyun Kim
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Correspondence to Young-Soo Park.

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Park, YS., Kotani, Y., Kim, T.K. et al. Efficacy and safety of intraventricular fibrinolytic therapy for post-intraventricular hemorrhagic hydrocephalus in extreme low birth weight infants: a preliminary clinical study. Childs Nerv Syst 37, 69–79 (2021). https://doi.org/10.1007/s00381-020-04766-5

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