Repeated lumbar or ventricular punctures in newborns with intraventricular hemorrhage

Intraventricular hemorrhage (IVH) is a major complication of premature birth and a cause of cerebral palsy and hydrocephalus. Repeated early lumbar puncture or ventricular taps have been advocated as a way of avoiding hydrocephalus and protecting the brain from pressure. It was thought that the risk of hydrocephalus and the need for a ventriculoperitoneal shunt might be reduced by the removal of protein and old blood in the cerebrospinal fluid. This hypothesis has been tested in four randomised trials involving premature infants in whom IVH (with or without established enlargement) was diagnosed by ultrasound. There is no evidence that early tapping of cerebrospinal fluid by lumbar puncture or ventricular tap reduces the risk of shunt dependence, disability, multiple disability or death. The use of repeated taps was associated with an increased risk of central nervous system infection. Thus the early use of early tapping cannot be recommended. Removing cerebrospinal fluid should be reserved for cases where there is symptomatic raised intracranial pressure.