Ventricular Lavage for premature babies with brain haemorrhage

Transcription

1 Ventricular Lavage for premature babies with brain haemorrhage Exceptional healthcare, personally delivered

2 Welcome to North Bristol NHS Trust At North Bristol NHS Trust we provide hospital and community healthcare to the residents of Bristol, South Gloucestershire and North Somerset, plus a specialist regional centre for neurosciences, plastics and burns, orthopaedics and renal services. Across our hospitals in Southmead and Frenchay - and our local community work through school nurses, health visitors and therapists -, the delivery of exceptional patient healthcare is at the heart of our Trust. 92% of our patients are happy with the care they receive from us and, every year, 6,000 patients and carers each take the time to write us a letter, thanking us for the care they received. Exceptional care As the largest hospital teaching Trust in the South West, we have internationally renowned teams delivering incredible outcomes for our patients through the hard work and dedication of our 9,000 doctors, nurses, healthcare professionals and support staff. For many years we have been at the forefront of new medical innovations, including brain and spinal surgery, joint replacement and the world s first radar breast imaging system. We provide award-winning services and receive a significant number of referrals from other hospitals for our range of specialist services. We treat over 250,000 patients a year, including the delivery of 5,800 babies. Each and every patient is treated with respect and dignity and, most important of all, as a person. 2 Ventricular Lavage for premature babies with brain haemorrhage

3 Personal care We want to make sure that during your stay with us you feel welcome, relaxed and confident in the care you receive. All our teams care about the quality of the service provided to you, from the moment you walk through the door until you leave. Protecting your privacy and dignity, all in-patient beds are in single sex areas and we have instigated protected visiting hours to ensure you get your full rest and recuperation. Safe care Patient and visitor safety is at the forefront of delivering exceptional healthcare. We not only focus on safe medical procedures, cleanliness and infection control but also personal safety while you visit us. We are recognised for our excellent patient safety and we gained a 5 star rating from Dr Foster s, the UK s leading independent provider of healthcare information. This rating means we are the safest hospital Trust in the South West and in the top 10% of hospital Trusts for patient safety in England. Patient safety also extends into how we hold your personal data. Our new Medical Records and Data Centre ensures your details are kept within state-of-the-art security with all records such as treatment notes, x-rays and prescriptions kept in one place. Efficient care By providing efficient healthcare, we will further reduce waiting times - you will be treated swiftly during your stay and we ll build seamless links with your GP and community social service teams. All-in-all, at North Bristol NHS Trust we believe in providing you with exceptional healthcare, that s personally delivered. Ventricular Lavage for premature babies with brain haemorrhage 3

4 Introduction This information is intended for parents whose babies are in the Neonatal Intensive Care Unit at Southmead Hospital. It explains: What is the procedure known as Ventricular Lavage used for? What are the benefits and risks of Ventricular Lavage? What does Ventricular Lavage involve? It is not a replacement for discussion with your doctors. It may help you to ask questions when you do talk to your baby s doctors. Why does my baby need Ventricular Lavage? Bleeding into the ventricles of the brain is a common complication of being born very early. The ventricles are spaces in the middle of the brain that normally contain a clear salty fluid, which flows out of the ventricles to circulate around the outside of the brain before draining away. The bleeding is known as intraventricular haemorrhage and is detected by the ultrasound brain scans performed on premature babies. Sometimes the blood inside the ventricles clogs up the drainage system. The salty fluid continues to be produced but can no longer drain away. This causes the fluid pressure to build up inside the ventricles and these become progressively larger. This enlargement of the ventricles is known as post-haemorrhagic ventricular dilatation. If this is untreated, the increasing fluid pressure, distortion and harmful substances produced by old blood can damage the brain and the head can swell. This can cause learning problems and difficulties with control of movement and posture, which may become noticeable after the first year of life. Conventional treatment has been to remove fluid by inserting a needle into the back (lumbar puncture). Because this could only be repeated a few times, it was usually necessary to take the baby to the operating theatre and, under general anaesthetic, insert a tube into the ventricles of the brain and attach this to a 4 Ventricular Lavage for premature babies with brain haemorrhage

5 small reservoir under the skin of the head. A needle could then be inserted into the reservoir as often as necessary, sometimes for up to 2-3 months before a permanent internal drainage system can be inserted (a shunt). Ventricular Lavage is a new treatment, which is aimed at reducing pressure and distortion early and washing out harmful substances from inside the ventricles, thus reducing further brain injury. What are the benefits of Ventricular Lavage? Ventricular Lavage was first developed at Southmead Hospital in 1998 and has been tested and refined since then. In a randomised controlled trial Ventricular Lavage reduced the number of infants with severe disability, especially mental disability, at age 2 years. Ventricular Lavage did not reduce the number of babies requiring a shunt operation. What are the risks of Ventricular Lavage? The main risk is secondary bleeding into the ventricles. However, secondary bleeding has always been straightforward to treat and was not associated with increased risk of disability. Since the trial, we have modified the procedure to reduce the risk of bleeding. The other theoretical risk is infection but there was no infection in any of the trial babies receiving lavage. If infection occurs, it can be treated. What does Ventricular Lavage involve? Your baby will be given a general anaesthetic in the neonatal unit. A small flexible tube will be inserted through the skin of the head into the ventricle on the right side of the brain. This tube will be used to give fluid. A similar tube will be inserted into the ventricle on the opposite side of the brain at the back of the head. This tube will be used to drain fluid. By passing clear fluid in one tube and draining fluid and blood out of the other, we remove harmful substances and old blood inside the ventricle. Ventricular Lavage for premature babies with brain haemorrhage 5

6 After a period to check that your baby is stable we allow fluid and old blood to drain from the tube on the left. At the same time we use the tube on the right to pump in sterile salt water (similar to the normal brain fluid) to wash out the ventricles. Two antibiotics, vancomycin and gentamicin, are added to the fluid, to reduce the risk of infection. The irrigation and drainage will be continued until the fluid coming out of the brain is free of blood. This is usually 72 hours but can be up to a week, after which both tubes will be removed, leaving the skin closed with one stitch at each insertion site. What will happen to my baby after Ventricular Lavage? Your baby will be carefully observed daily to see if he or she develops excessive head or ventricle enlargement. If this happens, your baby can still have standard treatment with lumbar punctures, a reservoir and, if necessary, a shunt. When your baby reaches full term (equivalent to about 40 weeks of pregnancy), we will arrange a magnetic resonance imaging (MRI) scan of the brain. This type of scan gives us much more information than ultrasound and helps to guide further treatment and advice. You will receive more information about MRI nearer the time. After leaving hospital for home, your baby will have development checks as an out-patient until the age of 2 years. As well as checking the growth of the head, these will involve assessing hearing, vision, movement, posture, speech and understanding. If necessary, we will arrange help for your baby from a children s physiotherapist, occupational therapist, speech therapist or psychologist. Your Decision You do not have to decide about this treatment immediately. You may want a day to think, read and talk to others or ask the doctors more questions before making the decision. 6 Ventricular Lavage for premature babies with brain haemorrhage

7 References and sources of further information Murphy BP, wt al (2002). Posthaemorrhagic ventricular dilatation in the premature infant: natural history and predictors of outcome. Arch Dis Child Fetal Neonatal Ed. Jul;87(1):F Savman K, et al (2001). Non-protein-bound iron is elevated in cerebrospinal fluid from preterm infants with posthemorrhagic ventricular dilatation. Pediatric Research 2001;49(2): Savman K, et al (2002). Cytokine response in cerebrospinal fluid from preterm infants with posthaemorrhagic ventricular dilatation. Acta Paediatr 2002;91(12): Whitelaw A, et al. (2003) Phase 1 Trial of prevention of hydrocephalus after intraventricular hemorrhage in newborn infants by Drainage, Irrigation, and Fibrinolytic Therapy. Pediatrics ;111(4): Whitelaw A, et al. (2007) Randomized clinical trial of prevention of hydrocephalus after intraventricular hemorrhage in preterm infants: brain-washing versus tapping fluid. Pediatrics; 119(5):e Whitelaw A (2010) Randomized Trial of Drainage, Irrigation and Fibrinolytic Therapy for Premature Infants with Post-Hemorrhagic Ventricular Dilatation: Developmental outcome at 2 years. Pediatrics epublication March 8. NHS Constitution. Information on your rights and responsibilities. Available at [Last Accessed March 2010] Ventricular Lavage for premature babies with brain haemorrhage 7

8 How to contact us: Neonatology Professor Andrew Whitelaw, H Neonatal Intensive Care Unit, Southmead Hospital andrew.whitelaw@bristol.ac.uk Paediatric Neurosurgery H Mr Ian Pople, Neurosurgery, Frenchay Hospital If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. First Published June NBT002194