Intervention Review

Intraventricular streptokinase after intraventricular hemorrhage in newborn infants

  1. Andrew Whitelaw1,*,
  2. David Odd2,
  3. Luc P Brion3,
  4. C R Kennedy4

Editorial Group: Cochrane Neonatal Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 30 MAY 2007

DOI: 10.1002/14651858.CD000498.pub2


How to Cite

Whitelaw A, Odd D, Brion LP, Kennedy CR. Intraventricular streptokinase after intraventricular hemorrhage in newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000498. DOI: 10.1002/14651858.CD000498.pub2.

Author Information

  1. 1

    University of Bristol, Neonatal Intensive Care Unit, Bristol, UK

  2. 2

    University of Bristol Medical School, Neonatal Medicine, Bristol, UK

  3. 3

    University of Texas Southwestern at Dallas, Division of Neonatal-Perinatal Medicine, Dallas, Texas, USA

  4. 4

    Southampton General Hospital, Department of Child Health, Southampton, UK

*Andrew Whitelaw, Neonatal Intensive Care Unit, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK. andrew.whitelaw@bristol.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Hydrocephalus following intraventricular hemorrhage (IVH) is still one of the most serious complications of premature birth. Ventriculoperitoneal shunt surgery cannot be carried out early and permanent dependence on a shunt is associated with several serious complications. Streptokinase could be useful in the treatment of post-hemorrhagic hydrocephalus. This form of therapy is based on the hypothesis that multiple blood clots in the cerebrospinal fluid (CSF) are the initial cause of post-hemorrhagic ventricular dilatation and lysis of clots could reopen the pathways of circulation and re-absorption of CSF.

Objectives

To determine the effect of intraventricular streptokinase after intraventricular hemorrhage on the risk of permanent shunt dependence, neurodevelopmental disability or death in neonates at risk for, or actually developing post-hemorrhagic hydrocephalus (PHH).

Search methods

Pediatric, Neurosurgical and General Medical Journals were handsearched from 1976 until October 2000, as well as the MEDLINE database (via PubMed) and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) up to April 2007. Personal contacts were used.

Selection criteria

Randomized controlled trials and quasi-randomized controlled trials evaluating the use of injection of streptokinase into the CSF in infants having or at risk for post-hemorrhagic hydrocephalus.

Data collection and analysis

Details of patient selection, patient allocation and the interventions were extracted. The end-points examined were: ventriculoperitoneal shunt, death, meningitis, and secondary hemorrhage.

Main results

Two randomized trials evaluated intraventricular streptokinase in infants developing post-hemorrhagic ventricular dilatation were identified When intraventricular streptokinase was compared with conservative management of post-hemorrhagic ventricular dilatation, the numbers of deaths and babies with shunt dependence were similar in both groups.

No information on the effect of intraventricular streptokinase on disability is available. There is cause for concern about meningitis and secondary intraventricular hemorrhage, but numbers are insufficient to quantify the risks.

Authors' conclusions

Intraventricular fibrinolytic therapy with streptokinase, given when post-hemorrhagic ventricular dilatation is established, cannot be recommended for neonates following IVH. A conservative approach with CSF drainage applied only to symptomatic raised intracranial pressure seems appropriate.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Intraventricular streptokinase after intraventricular hemorrhage in newborn infants

There is no evidence of benefit from giving streptokinase to newborn babies after brain haemorrhage.Bleeding (hemorrhage) into the ventricles of the brain is a serious complication of premature birth and large hemorrhages often lead to hydrocephalus, the process by which fluid accumulates under pressure inside the brain, expanding the head excessively and damaging the brain tissue. The insertion of a valve and drainage system (ventriculoperitoneal shunt) is fraught with problems in this patient group and alternatives to this therapy are needed. A possible approach is to try to dissolve the blood clots initially blocking the reabsorption of fluid in the brain. Streptokinase is a "clot-busting" agent that has been successfully used to unblock coronary arteries. The review found no good evidence that intraventricular injection of streptokinase to infants with large intraventricular hemorrhage or post-hemorrhagic ventricular enlargement reduces the need for ventriculoperitoneal shunt or improves outcome.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

腦室內鏈球菌激「酉每」 (streptokinase) 用於腦室內出血之新生兒

腦室內出血後的水腦症仍是早產最嚴重的併發症之一,礙於腦室腹腔引流管 (ventriculoperitoneal shunt) 放置手術不適合在急性期施行,永久放置亦可能導致嚴重併發症,鏈球菌激「酉每」的使用對於治療出血後水腦症 (posthemorrhagic hydrocephalus,PHH) 或許有幫助。此治療乃假定腦脊髓液中的血塊為導致出血後腦室擴大之主因,進而推論溶解血塊可幫助打通腦脊髓液之循環與吸收。

目標

針對腦室內出血高風險或已產生出血後水腦症之新生兒,使用腦室內鏈球菌激「酉每」對於永久性引流管依賴、神經發展遲緩或死亡的影響。

搜尋策略

針對自1976年至2000年10月間兒科、神經外科及一般醫學領域之論文做檢視,也從自1976年至2007年4月間MEDLINE及Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) 等資料庫做搜尋,同時還採用個人聯絡方式。

選擇標準

針對具高風險或已患出血後水腦症之嬰兒,評估注射鏈球菌激「酉每」至腦脊髓液之隨機或半隨機對照試驗。

資料收集與分析

採取病患篩選、分組與治療之細節。主要觀察之實驗結果為腦室腹腔引流、死亡、腦膜炎及次發性出血。

主要結論

共選出兩篇探討腦室內注射鏈球菌激「酉每」於出血後腦室擴大嬰兒之隨機試驗。發生死亡及需終生放置引流管之比例與保守療法之組別相近,並無任何腦室內注射鏈球菌激「酉每」對失能之影響的報告。對於導致腦膜炎及次發性腦室內出血之疑慮,則因患者人數不足而無法斷定其風險。

作者結論

不建議對於新生兒腦室內出血後的腦室擴大以鏈球菌激「酉每」進行腦室內血栓溶解療法,以保守療法加上顱內壓升高時的腦脊髓液引流治療似乎較為適當。

翻譯人

本摘要由馬偕醫院宋季純翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

並無證據顯示使用鏈球菌激「酉每」治療顱內出血後的新生兒有臨床助益。新生兒腦室內出血為早產的重大併發症之一,若出血量大易併發水腦,這是一種顱內積液、顱內壓升高並會破壞腦組織的情形。然而腦室腹腔引流管的放置亦常伴隨併發症,因此發展替代療法有其必要。嘗試將阻塞腦脊髓液吸收的血塊溶解可能是可行的方式,鏈球菌激「酉每」具有清除血塊的特性,已成功應用於冠狀動脈阻塞疾病。本文顯示無良好證據支持將鏈球菌激「酉每」用於嚴重的腦室內出血或出血後腦室擴大的新生兒,以降低腦室腹腔引流管的放置或改善預後。