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)

Introduction:

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.

Methods:

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.

Results:

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).

Conclusion:

DRIFT is the first intervention to demonstrate sustained reduction in disability after PHVD.