Serial lumbar tapping to prevent posthaemorrhagic hydrocephalus after intracranial haemorrhage in preterm infants
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Published on: March 28, 2025
W Müller1, B Urlesberger, U Maurer
1Department of Pediatrics, University of Graz, Austria.
Insights
Early serial lumbar tapping may help manage posthaemorrhagic ventricular dilation in preterm infants. This approach showed a low incidence of shunt implantation, suggesting its potential effectiveness in preventing severe hydrocephalus.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Neurosurgery
Background:
- Posthaemorrhagic ventricular dilation is a significant complication in preterm infants following intraventricular haemorrhage.
- Current treatment strategies for intraventricular haemorrhage and posthaemorrhagic ventricular dilation lack consensus.
- Serial lumbar tapping is a recognized intervention for existing or developing ventricular dilation.
Purpose of the Study:
- To evaluate the incidence of posthaemorrhagic hydrocephalus when serial lumbar tapping is initiated early, immediately before ventricular dilation begins.
- To assess the effectiveness of early-initiated serial lumbar tapping in preterm infants with intraventricular haemorrhage.
Main Methods:
- A cohort of 37 preterm infants with grade III or III+ intraventricular haemorrhage and periventricular haemorrhage was studied.
- Serial lumbar tapping was initiated as soon as possible after the onset of haemorrhage (median 2 days).
- A median of 11 lumbar punctures per patient was performed.
Main Results:
- Complete remission was observed in 16.2% of patients.
- 64.9% developed ventriculomegaly.
- 18.9% progressed to posthaemorrhagic hydrocephalus requiring shunt implantation.
Conclusions:
- Early initiation of serial lumbar tapping may be an effective strategy for managing posthaemorrhagic ventricular dilation.
- The low rate of shunt implantation suggests a potential benefit of this early intervention.
- Further reconsideration of early serial lumbar tapping protocols is warranted.
Abstract:
Posthaemorrhagic ventricular dilation following intraventricular haemorrhage is a serious problem with high morbidity in preterm babies. No consensus exists as to the treatment of intraventricular haemorrhage and as to the treatment or prophylaxis of posthaemorrhagic ventricular dilation. Serial lumbar tapping was already in use to treat existing or being in the offing ventricular dilation. In the present study we evaluated the incidence of posthaemorrhagic hydrocephalus when lumbar tapping was initiated early, i. e. immediately before ventricular dilation had started. Between January 1989 and December 1996 37 preterm infants suffering from intraventricular haemorrhage grade III or grade III plus periventricular haemorrhage were enrolled in this study. Lumbar tapping was started as soon as possible: median (25. percentile-75. percentile) two (0-4) days after onset of haemorrhage. A median of 11 (8-17) punctures was performed in each patient. The outcome was as follows: 6 patients (16.2%) showed complete remission, 24 (64.9%) developed ventriculomegaly and 7 (18.9%) developed posthaemorrhagic hydrocephalus with subsequent need of shunt implantation. With the low incidence of shunt implantations in our study we suggest to reconsider the effectiveness of SLP performed immediately after onset of haemorrhage.
