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Purpose <p>Neuroendoscopic lavage (NEL) has gained interest for the management of neonatal intraventricular haemorrhage (IVH) as a method for intraventricular haematoma and debris removal. However, evidence regarding efficacy, safety, and long-term outcomes remains limited and heterogeneous. A systematic synthesis of the available literature is warranted to evaluate potential efficacy and complication rates following NEL compared to conventional management strategies.</p> Methods <p>We carried out a systematic review and meta-analysis of original studies assessing outcomes for patients with neonatal IVH managed with NEL. Medline, Embase and Pubmed were searched from inception to 1st of April 2025. Outcomes included: shunt dependence, cerebrospinal fluid leak, post-procedure infection, rate of rebleed and neurodevelopmental outcomes.</p> Results <p>11 papers, encompassing 9 studies were included, with a cohort of 299 patients who underwent NEL. Following NEL the pooled shunt-dependence rate was 66.0% (95% CI:0.57–0.74) and the infection rate was 7.4% (95% CI: 0.02–0.13). The odds ratio (OR) of shunt-dependence with NEL compared to standard treatment (ventricular access device, ventriculo-subgaleal shunting or external ventricular drain) was 0.51 (95%CI:0.25–1.05, <i>p</i> = 0.07). There was a significantly reduced risk of post-operative infection with NEL compared to standard treatment (0.14, 95%CI: 0.06–0.34, <i>p</i> &lt; 0.0001). 69.1% of patients achieved a “good” Gross Motor Functional Classification Score (1–2) following NEL.</p> Conclusions <p>NEL appears to offer favourable outcomes for the management of neonatal IVH, with a potential reduction in the risk of shunt-dependence and a lower risk of infection than presented by VSGSs or VADs. Robust, high-quality data are needed to better establish NEL’s definitive role in the therapeutic algorithm for neonatal IVH.</p>

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Neuroendoscopic lavage for the management of neonatal post-haemorrhagic hydrocephalus: A systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年11月28日

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  • Susan Isabel Honeyman,
  • Sean Christopher Martin,
  • Tim Lawrence,
  • Amedeo Calisto,
  • Jayaratnam Jayamohan,
  • Shailendra Magdum

摘要

Purpose

Neuroendoscopic lavage (NEL) has gained interest for the management of neonatal intraventricular haemorrhage (IVH) as a method for intraventricular haematoma and debris removal. However, evidence regarding efficacy, safety, and long-term outcomes remains limited and heterogeneous. A systematic synthesis of the available literature is warranted to evaluate potential efficacy and complication rates following NEL compared to conventional management strategies.

Methods

We carried out a systematic review and meta-analysis of original studies assessing outcomes for patients with neonatal IVH managed with NEL. Medline, Embase and Pubmed were searched from inception to 1st of April 2025. Outcomes included: shunt dependence, cerebrospinal fluid leak, post-procedure infection, rate of rebleed and neurodevelopmental outcomes.

Results

11 papers, encompassing 9 studies were included, with a cohort of 299 patients who underwent NEL. Following NEL the pooled shunt-dependence rate was 66.0% (95% CI:0.57–0.74) and the infection rate was 7.4% (95% CI: 0.02–0.13). The odds ratio (OR) of shunt-dependence with NEL compared to standard treatment (ventricular access device, ventriculo-subgaleal shunting or external ventricular drain) was 0.51 (95%CI:0.25–1.05, p = 0.07). There was a significantly reduced risk of post-operative infection with NEL compared to standard treatment (0.14, 95%CI: 0.06–0.34, p < 0.0001). 69.1% of patients achieved a “good” Gross Motor Functional Classification Score (1–2) following NEL.

Conclusions

NEL appears to offer favourable outcomes for the management of neonatal IVH, with a potential reduction in the risk of shunt-dependence and a lower risk of infection than presented by VSGSs or VADs. Robust, high-quality data are needed to better establish NEL’s definitive role in the therapeutic algorithm for neonatal IVH.