Punciones lumbares o ventriculares repetidas en recién nacidos con hemorragia intraventricular
Información
- DOI:
- https://doi.org/10.1002/14651858.CD000216.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 06 abril 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Neonatología
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Andrew Whitelaw (AW) performed the original literature search, extracted data, and conducted the original Cochrane Review (Whitelaw 2001a). Yolanda Montagne, former Cochrane Neonatal Trials Search Coordinator, updated the search in 2009 and AW screened articles for potential inclusion. For this update, Richard Lee‐Kelland (RLK) updated the literature search, text, and analyses, and included a new analysis of outcomes 1.6 and 1.7. AW reviewed the updated search, text, and analyses.
Sources of support
Internal sources
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University of Bristol, UK.
External sources
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Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA.
Editorial support of the Cochrane Neonatal Review Group has been funded with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201600005C
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National Institute for Health Research, UK.
UK Editorial support for Cochrane Neonatal has been funded with funds from a UK National Institute of Health Research Grant (NIHR) Cochrane Programme Grant (13/89/12). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health.
Declarations of interest
AW is an author of one of the included trials (Ventriculomegaly 1990).
RLK has no known conflicts of interest.
Acknowledgements
We are very grateful to Colleen Ovelman, Managing Editor Cochrane Neonatal, for her assistance in completing this review update.
Version history
| Published | Title | Stage | Authors | Version |
| 2017 Apr 06 | Repeated lumbar or ventricular punctures in newborns with intraventricular haemorrhage | Review | Andrew Whitelaw, Richard Lee‐Kelland | |
| 2001 Jan 22 | Repeated lumbar or ventricular punctures in newborns with intraventricular hemorrhage | Review | Andrew Whitelaw | |
Differences between protocol and review
We added the methodology and plan for the 'Summary of findings' tables and GRADE recommendations, which were not in the original protocol or previous version of the review (Whitelaw 1998; Whitelaw 2001a).
For the 2016 review update, we did not include VPS or placement of ventricular reservoir as part of outcome 1.1 acquiring permanent shunt, or outcome 1.6 death or shunt, as the placement of a reservoir is a much milder outcome than a shunt.
We combined the outcomes of death and shunt as a new outcome: outcome 1.6 death or shunt.
Finally, we added a new outcome: outcome 1.7 presence of CSF infection before surgery. CSF infection (meningitis/ventriculitis) is a serious adverse outcome and repeated lumbar or ventricular punctures in preterm infants carries a theoretical risk of introducing infection.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- *Cerebral Ventricles;
- *Punctures [adverse effects];
- *Spinal Puncture [adverse effects];
- Cerebral Hemorrhage [complications, mortality, *therapy];
- Conservative Treatment [adverse effects];
- Controlled Clinical Trials as Topic;
- Hydrocephalus [etiology, *prevention & control];
- Infant, Premature;
- Non‐Randomized Controlled Trials as Topic;
- Randomized Controlled Trials as Topic;
- Retreatment;
- Ventriculoperitoneal Shunt [adverse effects];
Medical Subject Headings Check Words
Humans; Infant; Infant, Newborn;
PICO
Study flow diagram: review update
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study
Comparison 1 Lumbar punctures or ventricular punctures versus control, Outcome 1 Placement of a hydrocephalus shunt.
Comparison 1 Lumbar punctures or ventricular punctures versus control, Outcome 2 Death prior to 12‐month follow‐up.
Comparison 1 Lumbar punctures or ventricular punctures versus control, Outcome 3 Major disability in survivors.
Comparison 1 Lumbar punctures or ventricular punctures versus control, Outcome 4 Multiple disability in survivors.
Comparison 1 Lumbar punctures or ventricular punctures versus control, Outcome 5 Death or disability.
Comparison 1 Lumbar punctures or ventricular punctures versus control, Outcome 6 Death or shunt.
Comparison 1 Lumbar punctures or ventricular punctures versus control, Outcome 7 Infection of CSF presurgery.
| Repeated lumbar or ventricular punctures compared to conservative management for infants with intraventricular haemorrhage (IVH) | |||||
| Population: preterm infants less than three months of age with either: a) IVH demonstrated by ultrasound or computed tomography (CT) scan; or b) infants with IVH followed by progressive ventricular dilatation. Settings: neonatal intensive care units. Intervention: serial lumbar puncture, ventricular puncture, or tapping from a subcutaneous reservoir. Comparison: conservative management. | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants | Quality of the evidence | |
| Risk with conservative treatment | Risk with serial lumbar or ventricular punctures | ||||
| Hydrocephalus shunt | Study population | RR 0.96 | 233 | ⊕⊕⊕⊝ | |
| 469 per 1000 | 450 per 1000 | ||||
| Death | Study population | RR 0.88 | 280 | ⊕⊕⊝⊝ | |
| 199 per 1000 | 175 per 1000 | ||||
| Major disability in survivors | Study population | RR 0.98 | 141 | ⊕⊕⊕⊕ | |
| 761 per 1000 | 746 per 1000 | ||||
| Multiple disability in survivors | Study population | RR 0.90 | 141 | ⊕⊕⊕⊕ | |
| 537 per 1000 | 484 per 1000 | ||||
| Death or disability | Study population | RR 0.99 | 180 | ⊕⊕⊕⊕ | |
| 814 per 1000 | 806 per 1000 | ||||
| Death or shunt | Study population | RR 0.91 | 233 | ⊕⊕⊕⊝ | |
| 646 per 1000 | 588 per 1000 | ||||
| Infection of CSF presurgery | Study population | RR 1.73 | 195 | ⊕⊕⊝⊝ | |
| 43 per 1000 | 74 per 1000 | ||||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| GRADE Working Group grades of evidence | |||||
| 1Downgraded by 1 as Mantovani 1980 used an alternation method for random sequence generation. | |||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Placement of a hydrocephalus shunt Show forest plot | 3 | 233 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.73, 1.26] |
| 2 Death prior to 12‐month follow‐up Show forest plot | 4 | 280 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.53, 1.44] |
| 3 Major disability in survivors Show forest plot | 2 | 141 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.81, 1.18] |
| 4 Multiple disability in survivors Show forest plot | 2 | 141 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.66, 1.24] |
| 5 Death or disability Show forest plot | 2 | 180 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.86, 1.14] |
| 6 Death or shunt Show forest plot | 3 | 233 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.91 [0.75, 1.11] |
| 7 Infection of CSF presurgery Show forest plot | 2 | 195 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.73 [0.53, 5.67] |
