Irrigation and intraventricular fibrinolytic therapy for posthemorrhagic ventricular dilatation in preterm infants: does it improve neurodevelopmental outcome?

Evaluation of: Whitelaw A, Jary S, Kmita G et al.: Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years. Pediatrics 125, E852-E858 (2010). The aim of the study was to determine in a randomized trial whether ventricle drainage, irrigation and fibrinolytic therapy (DRIFT) altered the rate of death or severe neurodevelopmental disability at 24 months' corrected age in preterm infants with posthemorrhagic ventricular dilatation. Of the children assigned to DRIFT, 54% died or were severely disabled, versus 71% in the standard group. Among the survivors, 31% in the DRIFT group had severe cognitive disability (Mental Development Index score <55) versus 59% in the standard group. No differences were found in rates of children with Mental Development Index scores over 70. The study points to a potential meaningful intervention by removing toxic substances from hemorrhagic cerebrospinal fluid. Being a highly invasive intervention, however, further studies are required.