Repeated lumbar or ventricular punctures for preventing disability or shunt dependence in newborn infants with intraventricular hemorrhage.
BACKGROUND
This section is under preparation and will be included in the next issue.


OBJECTIVE
To determine whether repeated CSF tapping, by lumbar puncture or ventricular tap, reduced the risk of permanent shunt dependence, neurodevelopmental disability or death in neonates at risk of, or actually developing, post-hemorrhagic hydrocephalus (PHH). This form of treatment was based on the hypothesis that repeated tapping removed protein and blood from the CSF, thus clearing obstruction from the channels of CSF absorption.


METHODS
Pediatric, Neurosurgical and General Medical Journals were handsearched from 1976, as well as the Medline database. Personal contacts were used.


METHODS
Four controlled trials ( with five published papers) were identified, three being randomised and the fourth using alternative allocation. Two trials evaluated repeated lumbar punctures in neonates with intraventricular hemorrhage (IVH) and two trials evaluated repeated CSF tapping infants with IVH followed by progressive ventricular dilatation.


METHODS
In addition to details of the patient selection and patient allocation, the interventions were extracted. The end-points examined were: ventriculoperitoneal shunt, death, disability, multiple disability and death or disability.


RESULTS
The studies were sufficiently similar in the question they were asking and the interventions were sufficiently in common that they could be combined when assessing the effect of the intervention. When repeated CSF tapping was compared to conservative treatment, the relative risks for shunt placement, death, disability and multiple disability were very close to 1.0 with no statistically significant effect. There is also evidence that this form of treatment increased the risk of CSF infection.


CONCLUSIONS
Early repeated CSF tapping cannot be recommended for neonates at risk of, or actually developing, post-hemorrhagic hydrocephalus.
Whitelaw
A
A
Child Health, University of Bristol, Southmead Hospital, Bristol, UK, BS10 5NB. andrew.whitelaw@bristol.ac.uk
D002543:Cerebral Hemorrhage / Q000150:complications / Q000628:therapy*; D002552:Cerebral Ventricles; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000517:prevention & control*; D007231:Infant, Newborn; D011677:Punctures; D013129:Spinal Puncture