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Updated: Jul 23, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Intrathecal urokinase as a treatment for intraventricular hemorrhage in the preterm infant
R J Hudgins1, W R Boydston, P A Hudgins
1Department of Pediatric Neurosurgery, Scottish Rite Children's Medical Center, Atlanta, Ga, USA.
Insights
Intraventricular urokinase may reduce shunt placement and revisions in preterm infants with posthemorrhagic hydrocephalus. Low-dose urokinase significantly lowered shunt rates, suggesting a potential therapeutic benefit for IVH complications.
Area of Science:
- Neonatalogy
- Pediatric Neurosurgery
- Pharmacology
Background:
- Intraventricular hemorrhage (IVH) and posthemorrhagic hydrocephalus (PHH) are common in preterm infants.
- Shunt procedures for PHH are often complicated by obstruction and infection.
- PHH is typically caused by arachnoiditis from blood in the meninges.
Purpose of the Study:
- To investigate the efficacy of intraventricular urokinase in preventing or mitigating PHH progression after IVH.
- To assess the impact of urokinase on the need for shunt placement and revision rates.
Main Methods:
- 18 preterm infants with IVH and PHH received intraventricular urokinase via a subcutaneous reservoir.
- Infants were divided into low-dose (110,000-140,000 IU) and high-dose (280,000 IU) groups.
- Shunt placement and revision rates were compared to historical controls.
Main Results:
- No complications were observed with urokinase treatment.
- The overall shunt rate in the treatment group (71%) was lower than historical controls (92%), though not statistically significant (p=0.068).
- The low-dose urokinase group showed a significant reduction in shunt placement rate (37% vs. 92%, p<0.002).
- Shunt revision rates were lower in the urokinase-treated group (0.67 vs. 1.5 revisions/child).
Conclusions:
- Intraventricular urokinase shows promise in managing PHH in preterm infants.
- Low-dose urokinase significantly reduces the need for shunt placement.
- Urokinase treatment may decrease shunt revision rates, improving outcomes for infants with IVH-related hydrocephalus.
Abstract:
Despite improvements in the care of preterm infants, intraventricular hemorrhage (IVH) and posthemorrhagic hydrocephalus (PHH) continue to be frequent occurrences in this patient population. Shunt procedures in these children are frequently complicated by obstruction and/or infection. As the hydrocephalus is usually caused by an obliterative arachnoiditis due to contact of the blood with the basilar meninges, it was postulated that infusion of urokinase into the ventricles of infants who have sustained an IVH would clear the blood, mitigate the arachnoiditis, and prevent the progression of PHH. Accordingly, 18 preterm infants who had sustained IVH and subsequently developed PHH were treated with intraventricular urokinase instilled via a surgically implanted subcutaneous reservoir. There were no complications associated with the urokinase. Infants were divided into two dosage groups: low dose (110,000-140,000 IU total) and high dose (280,000 IU total). One infant in the low-dose group died at 1 month of life of respiratory complications. In the low-dose group, 3 of 8 (37%) infants required shunt placement; in the high-dose group, all 9 required shunt placement. For the total group, the shunt rate was 71%. This compares to a historical control group shunt rate of 92%. While the difference between the treatment group as a whole and control group approaches, but does not reach, statistical significance (p = 0.068), there was a significant reduction in the shunt rate when the low-dose group was considered separately (p < 0.002). For those infants that required shunt placement, there were fewer shunt revisions performed in the treatment group than in the control group during the first 24 months following shunt placement: 0.67 versus 1.5 shunt revisions/shunted child. Initial experience with intraventricular urokinase following IVH and PHH in preterm infants suggests a beneficial effect in reducing the shunt revision rate in both high- and low-dose groups. Reduction in shunt placement rate is seen only in the low-dose group.
