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Drainage, irrigation and fibrinolytic therapy (DRIFT) for premature infants with posthaemorrhagic ventricular dilatation; neurodisability at school-age

Presented at the Neonatal Society 2016 Summer Meeting.

Odd D1, Jary S2, Lea C2,3, Blair PS2,4, Young G2,4, Williams C2, Thai J5, Smith-Collins A2,3, Miller H2, Hollingworth W2, Aquilina K6, Pople I1, Morgan M1, Kmita G7, Whitelaw A2, Luyt K2,3

1 North Bristol NHS Trust, Bristol
2 University of Bristol, Bristol
3 St. Michael’s Hospital, Bristol
4 Bristol Randomised Trials Collaboration
5 CRIC Bristol
6 Great Ormond Street Hospital, London
7 University of Warsaw, Poland

Background: Intraventricular haemorrhage (IVH) with post-haemorrhagic ventricular dilatation (PHVD) is a serious neurological complication of prematurity, with significant neurodisability in survivors. No intervention has been proven to reduce long-term neurodisability after PHVD. Drainage, irrigation and fibrinolytic therapy (DRIFT) was developed as a novel method of ventricular lavage to clear the products of haemorrhage. Our aim was to perform definitive assessment at 10-years, to reach a valid conclusion about the sustained efficacy of DRIFT.

Methods: This study invited the children enrolled in the original DRIFT trial for detailed follow-up. Outcomes were cognitive quotient (CQ) and survival without severe cognitive disability. Secondary outcomes were visual function, sensorimotor disability and emotional/behavioural difficulties.

Results: Of the original trial cohort (n=77), 8 died before 2 years, 3 participants died after 2 years (all due to severe disability), 7 were lost to follow-up and 7 declined/did not respond. At 10 years 28 (DRIFT) and 24 (control) participants were assessed.

Drainage, irrigation and fibrinolytic therapy (DRIFT) for premature infants with posthaemorrhagic ventricular dilatation; neurodisability at school-age

Table: 1 – Giving those children who died due to disability post 2 years a score of 0; 2 – including the 3 deaths post 2 years that were due to disability as a negative outcome; 3 – including all 11 deaths as a negative outcome; 4 – one child in ??? complete a cognitive test; 5 – for one child a final GCA score was not collected however given the cognitive sub scores for this child it became clear that they were severely disabled; 6 – unadjusted results; 7 – adjusted for gender, ??? grade; £ – linear regression; $ – logistic regression

No differences were seen between the groups for the secondary outcomes.

Conclusion: Children in the DRIFT group had a 23.47 point CQ advantage (p=0.009) and were 9 times more likely to be alive without severe cognitive disability at 10-years (p=0.006). DRIFT is the first intervention to reduce long-term disability after PHVD. This life changing intervention should be developed as standard care for preterm infants with PHVD.

Corresponding author: karen.luyt@bristol.ac.uk

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