Abstract
Current therapies for posthaemorrhagic hydrocephalus (PHH) such as surgical shunting, repeated tapping and acetazolamide all have major problems and so we are exploring the possibilities of lysis of the obstructing clots. X oligomers, as indicators of fibrinolysis, were measured in CSF from 5 normal preterm infants (mean 102 ng/ml), 6 preterm infants with IVH but no PHH ( mean 315 ng/ ml) and 8 infants with progressive PHH (mean >500 ng/ ml). Serial CSF samples from one infant with IVH showed a peak X oligomer level over 1,000 ng/ml after 15 days.
4 infants were treated with repeated intraventricular injections of urokinase or streptokinase (2,500 or 5,000 units). CSF taken 2-3 days post-injection showed no change in the levels of X oligomers (already very high). Repeated doses were not associated with bleeding problems but hydrocephalus resolved in only one infant.
Conclusions: There is considerable natural fibrinolytic activity in the CSF after IVH. Single intraventricular injections of modest doses of fibrinolytic agents do not have a sustained effect on CSF fibrinolysis or hydrocephalus. Larger doses by infusion look more premising.
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Whitelaw, A., Creighton, L. & Gaffney, P. 11 FIBRINOLYSIS IN THE CSF FOLLOWING INTRAVENTRICULAR HAEMORHAGE. Pediatr Res 28, 279 (1990). https://doi.org/10.1203/00006450-199009000-00035
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DOI: https://doi.org/10.1203/00006450-199009000-00035
