Effectiveness of Ommaya sac combined with external ventricular drainage in improving neurological outcome after periventricular-intraventricular hemorrhage in neonates

Abstract

Objective To evaluate the effectiveness of Ommaya sac combined with external ventricular drainage in improving neurological function after periventricular-intraventricular hemorrhage (PIVH) in neonates. Methods A retrospective cohort study was carried out on the neonates hospitalized due to PIVH in the neonate and neurosurgery departments in our hospital from January 2015 to July 2020. They were divided into Ommaya sac combined with external ventricular drainage surgery group (surgery group) and non-surgery group. All of them were followed up until they were 12 months old. The concentration of inflammatory factors in cerebrospinal fluid in the early stage, the incidence of complications (epilepsy, hydrocephalus, cerebral palsy, and death) during follow-up, and neurodevelopmental outcomes were observed and analyzed in the 2 groups. Results A total of 71 PIVH neonates were enrolled, including 35 cases treated with Ommaya capsule combined with external ventricular drainage, and 36 cases treated without surgery. The levels of neuron enolase (NSE), nerve growth factor (NGF) and neutrophil-to-lymphocyte ratio (NLR) in the cerebrospinal fluid in 3 d after surgery were significantly decreased than the levels before surgery (P 0.05). During the follow-up to 12 months of corrected age, 1 neonate (2.9%) died in the surgery group and 6 neonates (16.7%) died in the non-surgery group. The incidences of complications in the surgery group and non-surgery group were compared as follows: epilepsy (0 vs 2 cases), hydrocephalus (4 vs 9 cases) and cerebral palsy (1 vs 3 cases), and statistical differences were seen in the incidences (P < 0.05). Gesell Developmental Scale score indicated that the developmental of the surviving children in the surgery group were significantly better than those in the non-surgery group in terms of adaptability, fine motor, language and personal social interaction (all P < 0.05). Conclusion Compared with non-surgical treatment, Ommaya sac combined with external ventricular drainage significantly reduces the concentration of inflammatory factors in the cerebrospinal fluid of neonates with moderate and severe PIVH, effectively decreases the incidence of PIVH complications, and improves the prognosis of neurological function.

Keywords

• neonate
• periventricular-intraventricular hemorrhage
• ommaya sac
• external ventricular drainage
• neurological prognosis