Is Ventricular Lavage The Novel Treatment For Neonatal Posthemorrhagic Hydrocephalus? A Meta analysis

Introduction: Intraventricular hemorrhage (IVH) may produce obliterative arachnoiditis, which disrupts the flow and absorption of cerebrospinal fluid (CSF), resulting in posthemorrhagic hydrocephalus (PHH). PHH gives a high risk of neurofunctional impairment. Drainage, irrigation and fibrinolytic therapy (DRIFT) and neuroendoscopic lavage (NEL) is the treatment options for PHH. This review’s aim is to determine the best treatment for PHH. Methods: This review is a meta-analysis using the PRISMA method guideline, including the clinical studies comparing ventricular lavage (VL)/ DRIFT/ NEL with conventional treatment for PHH between 2000 and 2021. Results: VL group reduce the shunt dependency compared to conventional treatment (OR = 0.22; 95CI 0.05 to 0.97; p = 0.05). VL group has less infection risk compared to the conventional treatment group (RR = 0.20; 95CI 0.07 to 0.59; p < 0.05). VL group may reduce the multiloculated hydrocephalus (OR = 0.27; 95CI 0.12 to 0.63; p < 0.05). The severe neurofunctional outcome is similar between the two groups (OR = 0.99; 95CI 0.13 to 7.23; p = 0.99). The early approach treatment group may give better neurofunctional outcome compared to the late approach (OR = 0.14; 95CI 0.06 to 0.35; p < 0.05). Conclusion: VL reduce the shunt dependency on the PHH, decreasing the shunt’s related infection rate. The early ventricular lavage may give benefit for the neurocognitive outcome.