Randomised trial of early tapping in neonatal posthaemorrhagic ventricular dilatation: results at 30 months. Ventriculomegaly Trial Group

Abstract

One hundred and fifty seven infants with progressive ventricular dilatation after intraventricular haemorrhage were randomised to either early repeated cerebrospinal fluid tapping or conservative management. Thirty two (20%) infants died and 13 (8%) were lost to follow up. One hundred and twelve children (90% of survivors) were examined at 30 months by a single experienced examiner. Overall, 54 (48%) scored less than 70 on the Griffiths developmental scales, 101 (90%) had neuromotor impairment, and 85 (76%) had marked disability; 63 (56%) had multiple impairments. Vision was severely affected in 10 (9%) and 30 (27%) had a field defect. Six per cent (seven children) had sensorineural hearing loss and 16 (14%) were taking regular anticonvulsant drugs. Although early cerebrospinal fluid tapping reduced the rate of ventricular and head expansion, there was no statistically significant difference (at the 5% level) between the treatment groups in the prevalence of neuromotor impairments, non-neuromotor impairments, nor multiple impairments at 30 months. These findings were consistent regardless of the presence or absence of a parenchymal cerebral lesion at entry to the trial. In the light of these findings and the 7% risk of cerebrospinal fluid infection associated with repeated tapping, this form of early intervention cannot be recommended.