The role of blood product removal in intraventricular hemorrhage of prematurity: a meta-analysis of the clinical evidence

Abstract

Introduction Premature neonates have a high risk of intraventricular hemorrhage (IVH) at birth, the blood products of which activate inflammatory cascades that can cause hydrocephalus and long-term neurological morbidities and sequelae. However, there is no consensus for one treatment strategy. While the mainstay of treatment involves CSF diversion to reduce intracranial pressure, a number of interventions focus on blood product removal at various stages including extraventricular drains (EVD), intra-ventricular thrombolytics, drainage-irrigation-fibrinolytic therapy (DRIFT), and neuroendoscopic lavage (NEL). Methods We performed a systematic review and meta-analysis to compare the risks and benefits commonly associated with active blood product removal treatment strategies. We searched MEDLINE, Embase, Scopus, Cochrane Library, and CINAHL databases through Dec 2020 for articles reporting on outcomes of EVDs, thrombolytics, DRIFT, and NEL. Outcomes of interest were rate of conversion to ventriculoperitoneal shunt (VPS), infection, mortality, secondary hemorrhage, and cognitive disability. Results Of the 10,398 articles identified in the search, 23 full-text articles representing 22 cohorts and 530 patients were included for meta-analysis. These articles included retrospective, prospective, and randomized controlled studies on the use of EVDs (n = 7), thrombolytics (n = 8), DRIFT therapy (n = 3), and NEL (n = 5). Pooled rates of reported outcomes for EVD,

[Retracted] Value of CSF‐Cl, CSF‐GS, CSF‐MALB, and CSF‐ADA in Differential Diagnosis of Secondary Hydrocephalus

“…Some studies have shown that there are differences in the expression of some inflammatory indexes in different neurosurgical diseases [ 11 , 12 ]. Detecting these inflammatory indicators can help us quickly identify the types of secondary hydrocephalus, so as to guide our clinicians to take reasonable and effective treatment measures to better improve the quality of life and prognosis of patients [ 13 , 14 ].…”

A standardised protocol for neuro-endoscopic lavage for post-haemorrhagic ventricular dilatation: A Delphi consensus approach

“…Whilst the principles of ventricular lavage in PHVD have remained consistent over time, there has been variation in the techniques proposed to deliver ventricular lavage [ 2 , 19 – 21 ]. Advantages have been described which favour NEL, for example, allowing direct visualisation of the progress of haematoma removal and therefore enabling targeted irrigation and clot removal under direct vision [ 1 ].…”

A Standardised Protocol for Neuro-endoscopic Lavage for Post-haemorrhagic Ventricular Dilatation: A Delphi Consensus Approach

“…Another advantage is that this procedure is often delivered during the time of insertion of a temporising device within the same operative session, avoiding additional risks associated with repeated procedures and sessions under general anaesthetic [19]. With neuro-endoscopic lavage emerging as a feasible and safe technique, technical variation between operating paediatric neurosurgeons exists [1–8, 19, 20]. Whilst this made the consensus process challenging, the discussion and multiple iterations that arose from the staged consensus process during this study were valuable and relevant.…”

“…Whilst the principles of ventricular lavage in PHVD have remained consistent over time, there has been variation in the techniques proposed to deliver ventricular lavage [2,[18][19][20]. Advantages have been described which favour NEL, for example, allowing direct visualisation of the progress of haematoma removal and therefore enabling targeted irrigation and clot removal under direct vision [1].…”