1300. Drainage Irrigation and Fibrinolytic Therapy (DRIFT) for post haemorrhagic ventricular dilatation: Improved cognitive ability at school-age
Award: First Place Pediatrics Eposter Award
Authors: Ian K. Pople, MD, IFAANS; Karen Luyt; Andrew Whitelaw, MD (Bristol, United Kingdom)
Drainage, irrigation and fibrinolytic therapy (DRIFT) was developed as a novel method of irrigating the ventricles to clear the effects of intraventricular haemorrhage (IVH) with post-haemorrhagic ventricular dilatation (PHVD). The DRIFT trial, conducted in 2003-6 randomised preterm infants to either DRIFT or standard therapy (CSF taps to control PHVD). At 2-years there was an apparent reduction in severe cognitive disability in the DRIFT group. In this study we aimed to determine if this benefit was sustained at 10 years.
77 preterm infants were recruited with IVH and progressive PHVD. In those randomised to DRIFT intraventricular injection of a fibrinolytic followed by continuous ventricular drainage via one catheter and continuous infusion with artificial CSF via a second catheter, maintaining ICP <7 mmHg, until CSF drainage cleared. Standard care consisted of LPs and CSF taps via reservoir. Children were followed up at median age of 10 years (range 8-12). Cognitive Quotient (CQ) was derived from British Ability Scales, Bayley Scales III and survival without severe cognitive disability.
Of 77 children randomized; 12 died of non-procedural causes and 12 were lost to follow-up at 10 years. 52 children were assessed at median age of 10-years; 28 DRIFT and 24 controls. Mean CQ was 69.3 (sd=30.1) in the DRIFT group and 53.7 (sd=35.7) in the standard group (unadjusted p=0.1; after adjustment for pre-specified variables sex, birthweight and grade of IVH, adjusted p=0.01). Survival without severe cognitive disability was 66% in the DRIFT group and 35% in the standard group (unadjusted p=0.019; adjusted p=0.003).
DRIFT is the first intervention to demonstrate sustained reduction in disability after PHVD.