A recent study found that a neurosurgical procedure called neuroendoscopic lavage (NEL) may be a safe option for intraventricular hemorrhage (IVH), a potential complication of fetal and neonatal alloimmune thrombocytopenia (FNAIT). Findings were published in Child’s Nervous System.
IVH is a subset of intracranial hemorrhage, a type of stroke that occurs due to bleeding in the brain. In patients with FNAIT, IVH can cause lifelong neurological complications, and can even be fatal in severe cases.
In some instances, shunts and drains are used to treat IVH. However, these techniques can cause complications, especially in neonates. Therefore, the authors evaluated 44 infants who were treated with NEL, a minimally invasive treatment that washes out blood clots in the brain, to determine whether this alternative method can be used safely.
Patients experienced significantly lower red blood cells counts and protein levels in the cerebrospinal fluid following NEL. “It has been proposed this reduction might (1) improve shunt survival, through minimising the risk of valve dysfunction or catheter blockage, and (2) reduce the number of patients who do require shunting,” the authors suggested.
Read more about FNAIT prognosis
After the procedure, six patients experienced post-operative complications, the most common of which was cerebrospinal fluid leak. Participants with a ventricular access device, which allows for long-term access to areas of the brain, had a higher risk of cerebrospinal fluid leaks.
Following NEL, 27 patients required further procedures including repeated washouts. Additionally, 26 patients required shunt insertion. The authors found that factors including gender, birth weight and gestational age did not differ between those who did and did not need a shunt. They did find, though, that infants who did not receive a stent were younger at the time of NEL.
The authors followed all 26 patients who received a stunt for 12 months. Of these individuals, 19 survived, representing a 73% survival rate.
Overall, the results show that while complications are still possible following NEL, the risks are lower than what has been observed with other techniques. “The procedure may reduce shunt dependence, particularly if performed earlier in the disease process,” the researchers noted.
The ENLIVEN-UK clinical trial is currently underway to assess the long-term outcomes of NEL, including neurodevelopmental status in patients at two years of age.
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