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Endogenous fibrinolysis in neonatal cerebrospinal fluid
1Paediatric Department, Aker University Hospital, Oslo, Norway.
Insights
Fibrinolytic activity in cerebrospinal fluid (CSF) is absent in normal infants but develops after intraventricular haemorrhage (IVH). This delayed fibrinolysis may be insufficient to prevent hydrocephalus in some infants.
Area of Science:
- Neonatal Neurology
- Cerebrospinal Fluid Dynamics
- Hemostasis and Thrombosis
Background:
- Intraventricular haemorrhage (IVH) is a common neonatal complication.
- The clearance of blood from cerebrospinal fluid (CSF) pathways after IVH is not well understood.
- Hydrocephalus can be a consequence of IVH, but the mechanisms of prevention are unclear.
Purpose of the Study:
- To investigate the presence and timing of fibrinolytic activity in CSF following IVH in infants.
- To determine if delayed fibrinolysis contributes to hydrocephalus development after IVH.
Main Methods:
- Fibrinolytic activity in CSF was measured using the fibrin plate method.
- CSF samples were collected from normal infants and infants diagnosed with IVH.
- Serial CSF sampling was performed in one infant to track fibrinolytic activity over time.
Main Results:
- Normal CSF exhibited no detectable fibrinolytic activity.
- CSF samples from infants within 17 days of IVH diagnosis showed no fibrinolytic activity.
- Significant fibrinolytic activity was detected in most CSF samples taken between 17 and 60 days post-IVH.
- One infant demonstrated a delay in fibrinolysis, with activity appearing around 19 days after IVH.
Conclusions:
- Delayed endogenous fibrinolysis in CSF is a common finding after intraventricular haemorrhage in infants.
- The onset of fibrinolytic activity in CSF is typically delayed following IVH.
- In some cases, this delayed fibrinolysis may be insufficient to effectively clear blood products and prevent the development of hydrocephalus.
Abstract:
Although many infants with intraventricular haemorrhage (IVH) recover without hydrocephalus, little is known about how blood is cleared from the CSF pathways. Fibrinolytic activity was measured by the fibrin plate method in CSF from 11 normal infants and 17 infants with IVH. Normal CSF showed no fibrinolytic activity. All the samples taken less than 17 days from diagnosis of IVH failed to show fibrinolytic activity. All but 1 of the CSF samples taken between 17 and 60 days of IVH showed fibrinolytic activity. In 1 infant where 14 serial samples were taken, there was no detectable fibrinolysis up to 16 days after IVH but from 19 to 52 days there was definite fibrinolytic activity. Delayed endogenous fibrinolysis in the CSF is common after IVH but may, in some cases, be insufficient to prevent hydrocephalus.