Summary of findings for the main comparison. Repeated lumbar or ventricular punctures compared to conservative treatment in newborns with intraventricular haemorrhage.
| Repeated lumbar or ventricular punctures compared to conservative management for infants with intraventricular haemorrhage (IVH) | |||||
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Population: preterm infants less than three months of age with either: a) IVH demonstrated by ultrasound or computed tomography (CT) scan; or b) infants with IVH followed by progressive ventricular dilatation. Settings: neonatal intensive care units. Intervention: serial lumbar puncture, ventricular puncture, or tapping from a subcutaneous reservoir. Comparison: conservative management. | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | |
| Risk with conservative treatment | Risk with serial lumbar or ventricular punctures | ||||
| Hydrocephalus shunt | Study population | RR 0.96 (0.73 to 1.26) | 233 (3 RCTs) | ⊕⊕⊕⊝ moderate1 | |
| 469 per 1000 | 450 per 1000 (342 to 591) | ||||
| Death | Study population | RR 0.88 (0.53 to 1.44) | 280 (4 RCTs) | ⊕⊕⊝⊝ low1,2 | |
| 199 per 1000 | 175 per 1000 (105 to 286) | ||||
| Major disability in survivors | Study population | RR 0.98 (0.81 to 1.18) | 141 (2 RCTs) | ⊕⊕⊕⊕ high | |
| 761 per 1000 | 746 per 1000 (617 to 898) | ||||
| Multiple disability in survivors | Study population | RR 0.90 (0.66 to 1.24) | 141 (2 RCTs) | ⊕⊕⊕⊕ high | |
| 537 per 1000 | 484 per 1000 (355 to 666) | ||||
| Death or disability | Study population | RR 0.99 (0.86 to 1.14) | 180 (2 RCTs) | ⊕⊕⊕⊕ high | |
| 814 per 1000 | 806 per 1000 (700 to 928) | ||||
| Death or shunt | Study population | RR 0.91 (0.75 to 1.11) | 233 (3 RCTs) | ⊕⊕⊕⊝ moderate1 | |
| 646 per 1000 | 588 per 1000 (485 to 717) | ||||
| Infection of CSF presurgery | Study population | RR 1.73 (0.53 to 5.67) | 195 (2 RCTs) | ⊕⊕⊝⊝ low2,3 | |
| 43 per 1000 | 74 per 1000 (23 to 241) | ||||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). Abbreviations: CI: confidence interval; CSF: cerebrospinal fluid; CT: computed tomography; IVH: intraventricular haemorrhage; RCT: randomised controlled trial; RR: risk ratio. | |||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | |||||
1Downgraded by 1 as Mantovani 1980 used an alternation method for random sequence generation. 2Downgraded by 1 due to imprecision, which is present because the width of the CI is consistent with both important benefit and harm. 3Downgraded by 1 due to inconsistency between studies. Dykes 1989 reported no cases of CSF infection. Ventriculomegaly 1990 reported infection in 10/157 cases.