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Child's Nervous System
Published in: Child's Nervous System 1/2021

01-01-2021 | Hydrocephalus | Original Article

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

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

Published in: Child's Nervous System | Issue 1/2021

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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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Metadata
Title
Efficacy and safety of intraventricular fibrinolytic therapy for post-intraventricular hemorrhagic hydrocephalus in extreme low birth weight infants: a preliminary clinical study
Authors
Young-Soo Park
Yukiko Kotani
Tae Kyun Kim
Hiroshi Yokota
Tadashi Sugimoto
Ichiro Nakagawa
Yasushi Motoyama
Hiroyuki Nakase
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 1/2021
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-020-04766-5

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