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Serial lumbar punctures in prevention of post-hemorrhagic hydrocephalus in preterm infants
Insights
Serial lumbar punctures did not prevent post-hemorrhagic hydrocephalus in preterm infants with severe intraventricular hemorrhage. This intervention showed no significant benefit over supportive care alone.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
Background:
- Severe intraventricular hemorrhage (IVH) in preterm infants poses a significant risk for developing post-hemorrhagic hydrocephalus (PHH).
- Hydrocephalus requiring intervention can lead to poor neurological outcomes in neonates.
Purpose of the Study:
- To evaluate the efficacy of intermittent lumbar punctures (LPs) in preventing PHH.
- To compare outcomes between infants receiving LPs and those receiving only supportive care.
Main Methods:
- A prospective controlled trial involving 47 preterm infants with grade 3 or 4 IVH.
- Treatment group underwent serial lumbar punctures for cerebrospinal fluid removal; control group received supportive care.
- Groups were comparable in birth weight, gestational age, sex, and hemorrhage severity.
Main Results:
- No statistically significant difference in hydrocephalus development between the LP and control groups (9 vs. 10 infants).
- Mortality rates were similar: 3 in the control group and 2 in the treatment group.
- The procedure involved an average of 16 taps over 20 days, removing approximately 67 ml of CSF.
Conclusions:
- Intermittent lumbar punctures were unsuccessful in preventing hydrocephalus in preterm infants with severe IVH.
- Further research may be needed to explore alternative or refined interventions for PHH prevention.
Abstract:
We studied 47 infants with either grade 3 or grade 4 intraventricular hemorrhage, to assess the efficacy of intermittent lumbar punctures in the prevention of post-hemorrhagic hydrocephalus in a prospective controlled trial. The control group received supportive care only, whereas the treatment group additionally underwent intermittent spinal taps. The spinal taps were started at postnatal age 11 +/- 5 days and continued for 20 +/- 16 days, with the removal of 67 +/- 101 ml cerebrospinal fluid using 16 +/- 12 taps. The two groups were comparable with regard to birth weight, gestational age, race, sex, Apgar score, and severity of hemorrhage. Three infants in the control group died, compared with two infants in the study group. Nine infants in the control group and 10 infants in the study group developed hydrocephalus requiring a ventriculoperitoneal shunt or a ventricular catheter reservoir. These differences in the outcome in the two groups are not statistically significant. We conclude that serial lumbar punctures were unsuccessful in prevention of hydrocephalus in this group of preterm infants with intraventricular hemorrhage.