Blood product removal reduces permanent shunting risk and mortality in infants with posthemorrhagic hydrocephalusBlood Product Removal Shows Lower Risks for Preterm Infants

OBJECTIVE: Intraventricular hemorrhage (IVH) is a major complication of extreme prematurity and a leading cause of posthemorrhagic hydrocephalus (PHH). Standard surgical treatment with temporary CSF diversion (TCD) for severe IVH often leads to permanent shunting and lifelong complications. This study compares blood product removal (BPR) and TCD only in reducing permanent cerebrospinal fluid (CSF) shunt dependence in preterm infants. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines to compare treatment outcomes (permanent CSF shunting, post-intervention CSF-related infections, secondary IVH, and mortality) in patients who underwent BPR versus TCD. RESULTS: Six studies involving 256 patients (128 patients in each treatment group) met inclusion criteria. Baseline demographics, including gestational age, birth weight, and IVH severity, were comparable between groups. BPR was associated with a lower risk of permanent shunting [RR: 0.67 (95% CI: 0.46-1.00) as compared to TCD (p = 0.047). The mean time to shunting was longer in the BPR group, but the difference was not statistically significant (79.6 vs 47.63 days; p = 0.267). TCD was associated with higher rates of CSF-related infections (26.54% vs 2.40%; p = 0.019) and mortality (19.27% vs 3.47%; p = 0.007). CONCLUSION: BPR was associated with a lower risk of permanent shunting and lower rates of mortality and CSF-related infections compared to TCD. While BPR presents a promising alternative to conventional TCD approaches, further studies are needed to validate these findings.