Drainage, Irrigation And Fibrinolytic Therapy (Drift) For Post-Haemorrhagic Ventricular Dilatation: 10-Year Follow-Up Of A Randomised Controlled Trial

Background:
Progressive ventricular dilatation after intraventricular haemorrhage (IVH) in preterm infants has a very high risk of severe disability and death. Drainage, irrigation and fibrinolytic therapy (DRIFT), in a randomised controlled trial (RCT), reduced severe cognitive impairment at two years.

Methods:
Objective: To assess if the cognitive advantage of DRIFT seen at two years persisted until school-age.

Participants: The RCT in four centres, recruited 77 preterm infants with IVH and progressive ventricular enlargement over specified measurements. Follow up was at age ten years.

Intervention: Intraventricular injection of a fibrinolytic followed by continuous lavage, until the drainage was clear. Standard care consisted of controlling expansion by lumbar punctures and if expansion persisted via a ventricular access device.

Primary outcome: Cognitive Quotient (CQ), derived from the British Ability Scales and Bayley III Scales and survival without severe cognitive disability.

Results:
Of the 77 children randomised; 12 died, two could not be traced, ten did not respond and one declined at ten year follow up. 28 in the DRIFT group and 24 in the standard treatment group were assessed by examiners blind to the intervention. Mean CQ was 69.3 (sd=30.1) in the DRIFT group and 53.7 (sd=35.7) in the standard treatment group (unadjusted p=0.1; after adjustment for the pre-specified variables sex, birthweight and IVH grade, adjusted p=0.01). Survival without severe cognitive disability was 66% in the DRIFT group and 35% in the standard treatment group (unadjusted p=0.019; adjusted p=0.003).

Conclusion:
DRIFT is the first intervention for PHVD to objectively demonstrate sustained cognitive improvement which may translate into lower odds of special school attendance.