Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2025
Neuroendoscopic lavage for the management of neonatal post-haemorrhagic hydrocephalus: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Honeyman Susan Isabel, Martin Sean Christopher, Lawrence Tim, Calisto Amedeo, Jayamohan Jayaratnam, Magdum Shailendra
Аннотация
PURPOSE: Neuroendoscopic lavage (NEL) has gained interest for the management of neonatal intraventricular haemorrhage (IVH) as a method for intraventricular haematoma and debris removal. However, evidence regarding efficacy, safety, and long-term outcomes remains limited and heterogeneous. A systematic synthesis of the available literature is warranted to evaluate potential efficacy and complication rates following NEL compared to conventional management strategies.
METHODS: We carried out a systematic review and meta-analysis of original studies assessing outcomes for patients with neonatal IVH managed with NEL. Medline, Embase and Pubmed were searched from inception to 1st of April 2025. Outcomes included: shunt dependence, cerebrospinal fluid leak, post-procedure infection, rate of rebleed and neurodevelopmental outcomes.
RESULTS: 11 papers, encompassing 9 studies were included, with a cohort of 299 patients who underwent NEL. Following NEL the pooled shunt-dependence rate was 66.0% (95% CI:0.57-0.74) and the infection rate was 7.4% (95% CI: 0.02-0.13). The odds ratio (OR) of shunt-dependence with NEL compared to standard treatment (ventricular access device, ventriculo-subgaleal shunting or external ventricular drain) was 0.51 (95%CI:0.25-1.05, p = 0.07). There was a significantly reduced risk of post-operative infection with NEL compared to standard treatment (0.14, 95%CI: 0.06-0.34, p < 0.0001). 69.1% of patients achieved a "good" Gross Motor Functional Classification Score (1-2) following NEL.
CONCLUSIONS: NEL appears to offer favourable outcomes for the management of neonatal IVH, with a potential reduction in the risk of shunt-dependence and a lower risk of infection than presented by VSGSs or VADs. Robust, high-quality data are needed to better establish NEL's definitive role in the therapeutic algorithm for neonatal IVH.
METHODS: We carried out a systematic review and meta-analysis of original studies assessing outcomes for patients with neonatal IVH managed with NEL. Medline, Embase and Pubmed were searched from inception to 1st of April 2025. Outcomes included: shunt dependence, cerebrospinal fluid leak, post-procedure infection, rate of rebleed and neurodevelopmental outcomes.
RESULTS: 11 papers, encompassing 9 studies were included, with a cohort of 299 patients who underwent NEL. Following NEL the pooled shunt-dependence rate was 66.0% (95% CI:0.57-0.74) and the infection rate was 7.4% (95% CI: 0.02-0.13). The odds ratio (OR) of shunt-dependence with NEL compared to standard treatment (ventricular access device, ventriculo-subgaleal shunting or external ventricular drain) was 0.51 (95%CI:0.25-1.05, p = 0.07). There was a significantly reduced risk of post-operative infection with NEL compared to standard treatment (0.14, 95%CI: 0.06-0.34, p < 0.0001). 69.1% of patients achieved a "good" Gross Motor Functional Classification Score (1-2) following NEL.
CONCLUSIONS: NEL appears to offer favourable outcomes for the management of neonatal IVH, with a potential reduction in the risk of shunt-dependence and a lower risk of infection than presented by VSGSs or VADs. Robust, high-quality data are needed to better establish NEL's definitive role in the therapeutic algorithm for neonatal IVH.