Role of ethamsylate in preventing periventricular-intraventricular hemorrhage in premature infants below 34 weeks of gestation.

OBJECTIVE: To determine the role of ethamsylate in prevention of PVH-IVH in premature infants <34 weeks gestational age. DESIGN: Prospective, randomized, controlled study. METHODS: Infants less than 34 weeks gestational age were included in the trial. Neonates with congenital malformations, family history of bleeding disorders and with Apgar scores <5 at 5 minutes were excluded. Subjects were randomized into two groups--Group A infants received intravenous ethamsylate (12.5 mg/kg) six hourly for four days and Group B infants served as a control group. Regular cranial ultrasounds to detect the presence of PVH-IVH were done between days 3-5, 10-14 and 28-30 of post natal age, and before hospital discharge in all infants and weekly in infants detected to have PVH-IVH on earlier scans. Various antenatal and postnatal factors known to affect the incidence of PVH-IVH were recorded. RESULTS: A total of 192 infants underwent the trial, 93 in Group A and 99 in Group B. Antenatal corticosteroids (1 or 2 doses) were administered to 32 ( 34.4%) and 36 (36.3%) women in Group A and Group B, respectively. None of the mothers received phenobarbitone, vitamin K or indomethacin antenatally and none of the infants received phenobarbitone, vitamin E or indomethacin postnatally during the study period. PVH-IVH was seen in 26 infants in Group A, of which Grade I IVH occurred in 9, Grade II in 14, Grade III in 2 and Grade IV in one infant. Twenty-nine infants had PVH-IVH in Group B of which 11 had Grade I, 15 Grade II and 3 Grade III. None of the differences were statistically significant. CONCLUSION: Postnatal administration of ethamsylate did not decrease the incidence of PVH-IVH in the study infants.

Prevençäo da hemorragia periventricular-intraventricular do prematuro: um enfoque farmacológico / Prevention of periventricular and intraventricular haemorrhage of the premature: a pharmacological approach

Apesar dos avanços verificados nos últimos anos em terapia neonatal intensiva, as hemorragias do sistema nervoso central ainda se constituem em expressivas causas morbi-mortalidade para os pequenos prematuros com menos de 35 semanas de idade gestacional e peso de nascimento inferior a 1500g. Sua ocorrência nas primeiras horas de vida pós-natal tem motivado sucessivas pesquisas no sentido de encontrar algum agente que, administrado precocemente, possa preveni-las. Discorre-se nesta revisäo sobre o uso de fenobarbital, brometo de pancurônio, etamsilato, vitamina E, indometacina e teofilina na prevençäo das hemorragias do sistema nervoso central, näo identificando nenhum de eficácia inteiramente comprovada