Neonatal cerebrospinal fluid plasminogen and plasminogen activator inhibitor-1 assay as predictors of posthemorrhagic hydrocephalus

Abstract

Massive intraventricular hemorrhage (IVH) in neonates is followed by progressive ventricular dilatation in 55–80% of cases if the infant survives. The initial mechanism of posthemorrhagic hydrocephalus (PHH) is thought to be obstruction by multiple small blood clots of the channels of the cerebrospinal fluid (CSF) to areas of absorption. Plasminogen activator inhibitor-1 (PAI-1) is the principal regulator of fibrinolysis in blood and one of the most highly controlled of the fibrinolytic components. The aim of this study is to measure plasminogen and PAI-1 levels in plasma and CSF of the neonates after IVH to assess endogenous fibrinolytic activity and to predict the development of PHH. Fifteen full term and preterm neonates with IVH were enrolled in the study. Ten neonates without IVH were used as a control group. Cranial ultrasound was performed at age of 2 weeks and 2 months. Plasma and CSF plasminogen and PAI-1 levels were assessed for these neonates. CSF PAI-1 was significantly higher in infants with IVH than in the controls (P < 0.001). There was no significant difference in the CSF and plasma plasminogen between infants with IVH and controls (P > 0.05). CSF PAI-1 was significantly higher in infants with PHH than in infants with posthemorrhagic ventricular dilatation (P < 0.05), with a sensitivity (100%) and specificity (100%). CSF PAI-1 is a very sensitive and specific parameter than CSF plasminogen for prediction of PHH in neonates with IVH, and this might be useful to evaluate the specific therapeutic programs of these neonates.

Keywords

Neonatal - plasminogen - hemorrhagic hydrocephalus