title: Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years.
abstract: BACKGROUND
  Preterm infants who develop posthemorrhagic ventricular dilatation (PHVD) have a high risk of cognitive and motor disability. No clinical intervention has been proven to reduce neurodevelopmental disability in such infants. We investigated whether drainage, irrigation, and fibrinolytic therapy (DRIFT), which aims to lower pressure, distortion, free iron, and cytokines, reduces death or severe disability in PHVD.
  
  
  METHODS
  We randomly assigned 77 preterm infants with PHVD to either DRIFT or standard treatment (ie tapping off cerebrospinal fluid to control excessive expansion). Severe disability was assessed at 2 years' corrected age and included severe sensorimotor disability and cognitive disability (<55 on the Bayley Mental Development Index).
  
  
  RESULTS
  Of 39 infants assigned to DRIFT, 21 (54%) died or were severely disabled versus 27 of 38 (71%) in the standard group (adjusted odds ratio 0.25 [95% confidence interval: 0.08-0.82]). Among the survivors, 11 of 35 (31%) in the DRIFT group had severe cognitive disability versus 19 of 32 (59%) in the standard group (adjusted odds ratio: 0.17 [95% confidence interval: 0.05-0.57]). Median Mental Development Index was 68 with DRIFT and <50 with standard care. Severe sensorimotor disability was not significantly reduced.
  
  
  CONCLUSIONS
  Despite an increase in secondary intraventricular bleeding, DRIFT reduced severe cognitive disability in survivors and overall death or severe disability.
authors.affiliation: Neonatal Medicine, University of Bristol Medical School, Southmead Hospital, Bristol BS10 5NB, United Kingdom. andrew.whitelaw@bristol.ac.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.forename: Sally
authors.initials: S
authors.lastname: Jary
authors.forename: Grazyna
authors.initials: G
authors.lastname: Kmita
authors.forename: Jolanta
authors.initials: J
authors.lastname: Wroblewska
authors.forename: Ewa
authors.initials: E
authors.lastname: Musialik-Swietlinska
authors.forename: Marek
authors.initials: M
authors.lastname: Mandera
authors.forename: Linda
authors.initials: L
authors.lastname: Hunt
authors.forename: Michael
authors.initials: M
authors.lastname: Carter
authors.forename: Ian
authors.initials: I
authors.lastname: Pople
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D004108:Dilatation, Pathologic; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D007507:Therapeutic Irrigation / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000150:complications / Q000175:diagnosis / Q000628:therapy*