Intervention Review

Diuretic therapy for newborn infants with posthemorrhagic ventricular dilatation

  1. Andrew Whitelaw1,*,
  2. Luc P Brion2,
  3. Colin R Kennedy3,
  4. David Odd1

Editorial Group: Cochrane Neonatal Group

Published Online: 23 APR 2001

Assessed as up-to-date: 22 APR 2007

DOI: 10.1002/14651858.CD002270


How to Cite

Whitelaw A, Brion LP, Kennedy CR, Odd D. Diuretic therapy for newborn infants with posthemorrhagic ventricular dilatation. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD002270. DOI: 10.1002/14651858.CD002270.

Author Information

  1. 1

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

  2. 2

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

  3. 3

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

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

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2001

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Abstract

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

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.

Objectives

To determine the effect of acetazolamide and furosemide on shunt dependence and other complications in infants developing post-hemorrhagic ventricular dilatation.

Search methods

Searches were performed of electronic databases (MEDLINE from 1966, EMBASE from 1974 and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library). PubMed was searched on April 18, 2007 and Issue 2, 2007 of The Cochrane Library was searched.

Selection criteria

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

Data collection and analysis

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.

Main results

There were two eligible trials: one randomized 16 infants and the other 177 infants. Neither study 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, 95% CI 1.02 - 1.58; RD 0.16, 95% CI 0.02 - 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, 95% CI 1.90 - 14.84; RD 0.19, 95% CI 0.09 - 0.29); meta-analysis confirmed this result.

Authors' 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.

 

Plain language summary

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

Diuretic therapy for newborn infants with posthemorrhagic ventricular dilatation

Bleeding (hemorrhage) into the fluid-producing cavities (ventricles) of the brain is a serious complication of premature birth. Large hemorrhages may result in fluid building up under pressure, progressively enlarging the brain and head. Current treatment approaches, including the insertion of a valve drainage system (shunt) are fraught with problems. Acetazolamide and furosemide, two drugs with diuretic action, reduce the production of fluid in the ventricles of the brain and have been proposed as safe treatments to treat dilatation of the ventricles after intraventricular hemorrhage in newborn infants. When compared with standard treatment, diuretic therapy was found not to reduce the need for shunt surgery. Diuretic drugs are neither safe nor effective in treating ventricular dilatation in infants with intraventricular hemorrhage.

 

摘要

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

背景

出血後腦室擴脹新生兒的利尿劑治療

腦室內出血依然是早產兒的嚴重併發症,出血後腦水腫仍然沒有滿意的治療方法。acetazolamide和利尿劑,由於均有減少腦脊液生成的作用,被提出作為減少腦水腫和腦室腹腔(VP) 分流術需要的非侵入性療法。

目標

確定acetazolamide和利尿劑對發生出血後腦室擴脹嬰兒對分流術依賴和其它併發症的效果。

搜尋策略

對電子數據庫(MEDLINE 從1966年起,EMBASE從1974年起,以及Cochrane對照試驗中心註冊資料庫(CENTRAL, Cochrane圖書館))進行了檢索。 2007年4月18日檢索了PubMed和2007年第2期的Cochrane圖書館。

選擇標準

比較acetazolamide和/或利尿劑與標準療法治療IVH 或出血後腦室擴脹嬰兒的隨機或半隨機試驗。

資料收集與分析

每位評價員獨立提取數據並按Cochrane協作組織的標準方法使用相對危險度(RR)和風險差(RD)進行分析,如果條件合適進行固定效應模型和敏感性分析。

主要結論

有兩項合格試驗: 其中一項隨機分配嬰兒16名,而另一項177名嬰兒。沒有一項研究顯示acetazolamide和利尿劑治療可以減少實施VP 分流,或者使VP分流或死亡的風險降低。規模較大的試驗表明acetazolamide和利尿劑治療顯示一歲時運動障礙有臨界意義增加的危險(RR 1.27, 95% CI 1.02  1.58; RD 0.16, 95% CI 0.02  0.31),但對存活者的發育遲緩、殘疾或運動障礙合併癒後風險,或一歲時發育遲緩、殘疾或運動障礙合併癒後風險則無統計學顯著性影響。規模較大試驗顯示利尿劑治療增加腎鈣質沉著症的風險(RR 5.31, 95% CI 1.90  14.84; RD 0.19, 95% CI 0.09  0.29);Meta分析證實了這一結果。

作者結論

acetazolamide和利尿劑療法治療出血後腦室擴脹既無效也不安全。不推薦acetazolamide和利尿劑用於出血後腦水腫治療。

翻譯人

本摘要由臺中榮民總醫院薛榮華翻譯。

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

總結

出血(出血)到大腦的液體生成腔(腦室)是一個嚴重的早產併發症。大量出血可能會導致液體累積壓力下,逐步擴大腦部和頭部。目前的治療方法,包括插入一個閥排水系統(分流)是存在一些問題。Acetazolamide與 furosemide,兩種藥物有利尿作用,減少腦室內液體產生,並已提出作為新生嬰兒出血後腦室擴脹安全的治療方法。與標準治療相比,利尿劑治療無法減少分流手術的需求。利尿藥物,治療嬰幼兒出血後腦室擴脹既不安全也沒有效。