Drainage, irrigation and fibrinolytic therapy (DRIFT) for posthaemorrhagic ventricular dilatation: 10-year follow-up of a randomised controlled trial

Arch Dis Child Fetal Neonatal Ed. 2020 Sep;105(5):466-473. doi: 10.1136/archdischild-2019-318231. Epub 2020 Jul 4.


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 2 years.

Objective: To assess if the cognitive advantage of DRIFT seen at 2 years persisted until school age.

Participants: The RCT conducted in four centres recruited 77 preterm infants with IVH and progressive ventricular enlargement over specified measurements. Follow-up was at 10 years of age.

Intervention: Intraventricular injection of a fibrinolytic followed by continuous lavage, until the drainage was clear, and standard care consisting of control of 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, 2 could not be traced, 10 did not respond and 1 declined at 10-year follow-up. 28 in the DRIFT group and 24 in the standard treatment group were assessed by examiners blinded to the intervention. The mean CQ score 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; adjusted p=0.01, after adjustment for the prespecified variables sex, birth weight and IVH grade). 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 posthaemorrhagic ventricular dilatation to objectively demonstrate sustained cognitive improvement.

Trial registration number: ISRCTN80286058.

Keywords: intraventricular haemorrhage; neonatal; neurodevelopment; post-haemorrhagic ventricular dilatation; preterm.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Cerebral Intraventricular Hemorrhage / complications
  • Cerebral Intraventricular Hemorrhage / therapy*
  • Child
  • Child Behavior
  • Child, Preschool
  • Cognitive Dysfunction / prevention & control*
  • Dilatation, Pathologic
  • Drainage / methods
  • Female
  • Follow-Up Studies
  • Heart Ventricles / physiopathology
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / therapy*
  • Male
  • Spinal Puncture
  • Therapeutic Irrigation / methods
  • Thrombolytic Therapy / methods
  • Visual Acuity