Treatment thresholds for intervention in posthaemorrhagic ventricular dilation: a randomised controlled trial
- Resource Type
- Authors
- Vries, L.S. de; Groenendaal, F.; Liem, K.D.; Heep, A.; Brouwer, A.J.; van't Verlaat, E.; Benavente-Fernandez, I.; Straaten, H.L.M. van; Wezel-Meijler, G. van; Smit, B.J.; Govaert, P.; Woerdeman, P.A.; Whitelaw, A.; Han, K.; Steggerda, S.; Benders, M.J.N.L.; Dudink, J.; Horst, H.J. ter; Dijkman, K.P.; Ley, D.; Fellman, V.; Haan, T.R. de; Quijano, T.A.; Barcik, U.; Mathur, A.; Graca, A.M.; ELVIS Study Grp
- Source
- Archives of disease in childhood. Fetal and neonatal edition, 104(1), F70-F75
Archives of Disease in Childhood : Fetal and Neonatal Edition, 104, F70-F75
Archives of Disease in Childhood : Fetal and Neonatal Edition, 104, 1, pp. F70-F75
Archives of Disease in Childhood. Fetal and Neonatal Edition, 104(1), F70-F75. BMJ Publishing Group
Archives of Disease in Childhood Fetal and Neonatal Edition, 104(1), F70. BMJ Publishing Group
ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, 104(1), F70-F75. BMJ PUBLISHING GROUP
- Subject
- Male
DRAINAGE
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
Infant, Premature, Diseases
Diseases/surgery
Pediatrics
Severity of Illness Index
Spinal Puncture
THERAPY
Cerebral Ventricles
law.invention
0302 clinical medicine
Randomized controlled trial
law
Neonatal
Obstetrics and Gynaecology
Surgical/methods
Portasystemic Shunt, Surgical
Medicine
030212 general & internal medicine
PREMATURE-INFANTS
HYDROCEPHALUS
Infant, Premature, Diseases/surgery
OUTCOMES
imaging
Obstetrics and Gynecology
Gestational age
General Medicine
Cerebral Hemorrhage/surgery
Perinatology
INTRAVENTRICULAR HEMORRHAGE
and Child Health
Multicenter Study
Intensive Care Units
Intraventricular hemorrhage
Cerebrovascular Circulation
Portasystemic Shunt, Surgical/methods
Anesthesia
Randomized Controlled Trial
GROWTH
Gestation
Female
Infant, Premature
Shunt (electrical)
Dilatation, Pathologic
BIRTH-WEIGHT INFANTS
medicine.medical_specialty
Gestational Age
neonatology
03 medical and health sciences
All institutes and research themes of the Radboud University Medical Center
Intensive Care Units, Neonatal
PRETERM INFANTS
Intensive care
Severity of illness
Journal Article
Humans
Pediatrics, Perinatology, and Child Health
Neonatology
Portasystemic Shunt
Premature
Cerebral Hemorrhage
Pathologic
business.industry
DILATATION
intraventricular haemorrhage
Infant, Newborn
Infant
Newborn
medicine.disease
post haemorrhagic ventricular dilatation
Pediatrics, Perinatology and Child Health
preterm
business
030217 neurology & neurosurgery
Cerebral Ventricles/surgery
- Language
- English
- ISSN
- 1359-2998
ObjectiveTo compare a low versus a higher threshold for intervention in preterm infants with posthaemorrhagic ventricular dilatation.DesignMulticentre randomised controlled trial (ISRCTN43171322).Setting14 neonatal intensive care units in six countries.Patients126 preterm infants ≤34 weeks gestation with ventricular dilatation after grade III–IV haemorrhage were randomised to low threshold (LT) (ventricular index (VI) >p97 and anterior horn width (AHW) >6 mm) or higher threshold (HT) (VI>p97+4 mm and AHW >10 mm).InterventionCerebrospinal fluid tapping by lumbar punctures (LPs) (max 3), followed by taps from a ventricular reservoir, to reduce VI, and eventually a ventriculoperitoneal (VP) shunt if stabilisation of the VI below the p97+4 mm did not occur.Composite main outcome measureVP shunt or death.Results19 of 64 (30%) LT infants and 23 of 62 (37%) HT infants were shunted or died (P=0.45). A VP shunt was inserted in 12/64 (19%) in the LT and 14/62 (23%) infants in the HT group. 7/12 (58%) LT infants and 1/14 (7%) HT infants required shunt revision (PConclusionsThere was no significant difference in the primary composite outcome of VP shunt placement or death in infants with posthaemorrhagic ventricular dilatation who were treated at a lower versus a higher threshold for intervention. Infants treated at the lower threshold received more invasive procedures. Assessment of neurodevelopmental outcomes will provide further important information in assessing the risks and benefits of the two treatment approaches.