Table 1:
Comparisons of Lumber Punctures in Studies Included in the Cochrane Review1
| Anwar et al.2 (n=24) | Mantovani et al.3 (n=19) | Dykes et al.4 (n=22) | Ventriculomegaly Group5, 6 (n= 79) |
||
|---|---|---|---|---|---|
| Indications | Infants with Grade III-IV IVH | Infants with Grade II-III IVH | Asymptomatic severe progressive posthemorrhagic hydrocephalus | VI > 97th percentile + 4 mm | |
| Time to start LPs | 11 Days (SD=5) | 19 days (SD=11) | |||
| Number of LPs | 14 (SD= 10) | Median (10–90th %) 7 (1–37) | |||
| Aimed volume and end point | • Daily LP till flow stops • LP were done every other day, or less if CSF removed at tap was <3 ml. • LPs stopped if the ventricular size decreased or remained unchanged for 2 consecutive weeks |
• Daily LP until the CSF was clear, colorless, and had a protein concentration less than 180 | • Daily LP for a minimum of 1 week and a maximum of 3 weeks. | • LP for max 2% of body weight • Repeat as many aspossible if increase VI > 2mm above measurement before first tap • If LP < 2 ml then shift for Ventricular tap |
|
| Volume (ml) | Total: 67 (SD=10) | Median (10–90th%) 116 (14–678) | |||
| Volume per tap (ml) | Mean= 3 (SD=2) | 3–5 ml | 2–21 ml | ||
| Duration | 20 days (SD= 16) | 18 days (range 7–34) | 1–3 weeks | ||
| Special Description | Screening done to all infants using LP at 24 hours and 72 hours of life. If concerning, CT was done. | Spinal tap only (42%) Ventricular tap (9%) Spinal and Ventricular tap or reservoir (42%) |
|||
| Outcomes | |||||
| VPS | NA | 4/19 (21%) | 9/22 (41%) | 41/79 (52%) | |
| Death or Disability | 14/21 (67%) | 61/73 (84%) | |||
Whitelaw A, Lee-Kelland R. Repeated lumbar or ventricular punctures in newborns with intraventricular haemorrhage. The Cochrane database of systematic reviews. 2017;4:Cd000216.
Anwar M, Kadam S, Hiatt IM, Hegyi T. Serial lumbar punctures in prevention of post-hemorrhagic hydrocephalus in preterm infants. J Pediatr. 1985;107:446–50.
Mantovani JF, Pasternak JF, Mathew OP, Allan WC, Mills MT, Casper J, et al. Failure of daily lumbar punctures to prevent the development of hydrocephalus following intraventricular hemorrhage. J Pediatr. 1980;97:278–81.
Dykes FD, Dunbar B, Lazarra A, Ahmann PA. Posthemorrhagic hydrocephalus in high-risk preterm infants: natural history, management, and long-term outcome. J Pediatr. 1989;114:611–8.
Group VT. Randomised trial of early tapping in neonatal posthaemorrhagic ventricular dilatation. Ventriculomegaly Trial Group. Arch Dis Child. 1990;65:3–10.
Group VT. Randomised trial of early tapping in neonatal posthaemorrhagic ventricular dilatation: results at 30 months. Ventriculomegaly Trial Group. Arch Dis Child Fetal Neonatal Ed. 1994;70:F129–36.