Safety and Efficacy of Neuroendoscopic Lavage for the Management of Neonatal Intraventricular Hemorrhage.

Introduction: Neonatal intraventricular haemorrhage (IVH) is a common complication of preterm birth and optimal treatment strategy remains an area of uncertainty. Neuroendoscopic lavage (NEL) has gained interest as a method for removal of intraventricular haematoma and debris, with outcomes suggesting it to be safe and potentially efficacious for reducing the requirement of ventriculoperitoneal shunting. To the best of our knowledge, we present the largest global series to assess the outcomes from NEL for the management of neonatal IVH.

Methods: A retrospective review was carried out, between January 2011 and November 2023, identifying infants who underwent NEL for hydrocephalus following germinal matrix haemorrhage at our institution. Data was extracted on patient baseline demographics, co-morbidities, complications, re-operation rate and shunt requirement.

Results: We identified 45 patients (29M:16F), who underwent NEL at a median corrected age of 36 weeks and 0 days (range, 29 weeks and 5 days to 61 weeks and 4 days). 28 patients underwent a simultaneous endoscopic third ventriculostomy (ETV). 7/45 (15.6%) had post-procedure complications: 5 CSF leaks (11.1%), 3 infections (6.7%) and 1 rebleed within 72hrs of NEL (2.2%). 27/45 patients (60.0%) went on to require a ventriculoperitoneal shunt (VPS). The relative risk of requiring VPS insertion if a patient underwent NEL+ ETV compared with NEL alone was 0.88 (95%CI: 0.548 – 1.42; p=0.609). The 12-month shunt survival rate was 19/27 (70.4%). On multivariate analysis, a significant baseline predictor of shunt independence was undergoing NEL at an earlier corrected age (p=0.007).

Conclusion : NEL is safe and potentially efficacious treatment for neonatal IVH. The procedure may reduce shunt dependence, particularly if performed earlier in the disease process. For those who require CSF diversion NEL is associated with improved shunt survival.