Affiliations: Department of Pediatrics, Faculty of Medicine, Tanta
University, Tanta, Egypt | Department of Clinical Pathology, Faculty of Medicine,
Tanta University, Tanta, Egypt | Department of Diagnostic Radiology, Faculty of
Medicine, Tanta University, Tanta, Egypt
Note: [] Correspondence: Sahar A. Abd El-Aziz, Department of Pediatrics,
Faculty of Medicine, Tanta University, Tanta, Egypt. Tel.: +20 403313706; +20
403349857; E-mail: dr.sahar_2007@yahoo.com
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.
