Diuretic therapy for newborn infants with posthemorrhagic ventricular dilatation.
BACKGROUND
Intraventricular hemorrhage remains a serious complication of premature birth and post hemorrhagic hydrocephalus still has no satisfactory treatment. Acetazolamide and furosemide, which both reduce the production of cerebrospinal fluid, have been suggested as non-invasive therapies to reduce hydrocephalus and the need for ventriculo-peritoneal (V-P) shunting.


OBJECTIVE
The aim of this review was to determine whether the use of acetazolamide and furosemide improves outcome, especially shunt dependence, in infants developing post-hemorrhagic ventricular dilatation.


METHODS
The standard search strategy of the Cochrane Collaboration was used.


METHODS
Randomised, or quasi-randomised trials, of acetazolamide and/or furosemide compared with standard therapy in infants with IVH or post-hemorrhagic ventricular dilatation


METHODS
Data were extracted independently by each author and were analysed by the standard methods of the Cochrane Collaboration using relative risk (RR) and risk difference (RD), a fixed effect model and sensitivity analyses where appropriate.


RESULTS
There were two eligible trials: one randomized 16 infants and the other, 177. Neither showed a decreased risk for V-P shunt or for V-P shunt or death associated with acetazolamide and furosemide therapy. The larger trial showed that acetazolamide and furosemide treatment resulted in a borderline increase in the risk for motor impairment at one year (RR 1.27, CI 1.02 to 1.58; RD 0.16, CI 0.02 to 0.31), but did not significantly affect the risk for the combined outcome of delay, disability or motor impairment among survivors, or the risk of the combined outcome of death, delay, disability or impairment at one year. The larger trial showed that diuretic treatment increased the risk for nephrocalcinosis (RR 5.31, CI 1.90 to 14.84; RD 0.19, CI 0.09 to 0.29); meta-analysis confirmed this result.


CONCLUSIONS
Acetazolamide and furosemide therapy is neither effective nor safe in treating post hemorrhagic ventricular dilatation. Acetazolamide and furosemide cannot be recommended as therapy for post hemorrhagic hydrocephalus.
Whitelaw
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A
Division of Child Health, University of Bristol, Division of Child Health, Southmead Hospital, Bristol, UK, BS10 5NB. andrew.whitelaw@bristol.ac.uk
Kennedy
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CR
Brion
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LP
D000086:Acetazolamide / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000150:complications*; D002552:Cerebral Ventricles; D004108:Dilatation, Pathologic / Q000188:drug therapy / Q000209:etiology; D004232:Diuretics / Q000627:therapeutic use*; D005665:Furosemide / Q000627:therapeutic use*; D006801:Humans; D006849:Hydrocephalus / Q000188:drug therapy* / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D016032:Randomized Controlled Trials as Topic; D017287:Ventriculoperitoneal Shunt
D004232:Diuretics; D005665:Furosemide; D000086:Acetazolamide