Young-Soo Park1,2, Yukiko Kotani3, Tae Kyun Kim3, Hiroshi Yokota3, Tadashi Sugimoto3, Ichiro Nakagawa3, Yasushi Motoyama3, Hiroyuki Nakase3. 1. Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan. park-y-s@naramed-u.ac.jp. 2. Division of Neurosurgery, Children's Medical Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, Japan. park-y-s@naramed-u.ac.jp. 3. Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan.
Abstract
PURPOSE: To evaluate the efficacy and safety of our unique therapy for treating post-intraventricular hemorrhagic hydrocephalus (PIVHH) in low birth weight infants (LBWls) through an early stage fibrinolytic therapeutic strategy involving urokinase (UK) injection into the lateral ventricle, called the "Ventricular Lavage (VL) therapy." METHODS: Overall, 43 consecutive infants with PIVHH were included. Most were extremely LBWIs (n = 39). Other cases included very LBWIs (n = 2) and full-term infants (n = 2). VL therapy involved continuous external ventricular drainage (EVD) management using a very fine catheter and intermittent slow injection of 6000 IU of UK every 3-6 h to actively dissolve hematomas. RESULTS: Early EVD management (within 3 weeks of IVH onset) was performed in 25 infants, with combination VL therapy in 21 infants. Five initiated late EVD management (≥ 3 weeks after IVH onset); the remaining 13 were treated conservatively for several weeks, delaying surgical intervention. Eighteen of 21 (86%) infants who received VL therapy did not require permanent shunt surgery. There were no serious complications, including the absence of secondary hemorrhage and infection. Two-thirds of the infants treated in the late stages required permanent shunt, and various shunt-related complications frequently occurred. A good outcome occurred in 13/17 infants in the early treatment group, despite most subjects having an IVH grade IV, and in 6/15 in the late treatment group. CONCLUSIONS: Permanent shunt surgery needs were dramatically reduced following early VL therapy, and functional outcomes were favorable. VL therapy might be a promising strategy that could lead to the development of new treatments for PIVHH.
PURPOSE: To evaluate the efficacy and safety of our unique therapy for treating post-intraventricular hemorrhagic hydrocephalus (PIVHH) in low birth weight infants (LBWls) through an early stage fibrinolytic therapeutic strategy involving urokinase (UK) injection into the lateral ventricle, called the "Ventricular Lavage (VL) therapy." METHODS: Overall, 43 consecutive infants with PIVHH were included. Most were extremely LBWIs (n = 39). Other cases included very LBWIs (n = 2) and full-term infants (n = 2). VL therapy involved continuous external ventricular drainage (EVD) management using a very fine catheter and intermittent slow injection of 6000 IU of UK every 3-6 h to actively dissolve hematomas. RESULTS: Early EVD management (within 3 weeks of IVH onset) was performed in 25 infants, with combination VL therapy in 21 infants. Five initiated late EVD management (≥ 3 weeks after IVH onset); the remaining 13 were treated conservatively for several weeks, delaying surgical intervention. Eighteen of 21 (86%) infants who received VL therapy did not require permanent shunt surgery. There were no serious complications, including the absence of secondary hemorrhage and infection. Two-thirds of the infants treated in the late stages required permanent shunt, and various shunt-related complications frequently occurred. A good outcome occurred in 13/17 infants in the early treatment group, despite most subjects having an IVH grade IV, and in 6/15 in the late treatment group. CONCLUSIONS: Permanent shunt surgery needs were dramatically reduced following early VL therapy, and functional outcomes were favorable. VL therapy might be a promising strategy that could lead to the development of new treatments for PIVHH.
Authors: Walufu Ivan Egesa; Simon Odoch; Richard Justin Odong; Gloria Nakalema; Daniel Asiimwe; Eddymond Ekuk; Sabinah Twesigemukama; Munanura Turyasiima; Rachel Kwambele Lokengama; William Mugowa Waibi; Said Abdirashid; Dickson Kajoba; Patrick Kumbowi Kumbakulu Journal: Int J Pediatr Date: 2021-03-16
Authors: Mohamed El-Dib; David D Limbrick; Terrie Inder; Andrew Whitelaw; Abhaya V Kulkarni; Benjamin Warf; Joseph J Volpe; Linda S de Vries Journal: J Pediatr Date: 2020-07-30 Impact factor: 4.406