Acetazolamide and furosemide for posthemorrhagic hydrocephalus of the newborn

• Published in: Pediatric neurology Vol. 20; no. 3; pp. 185 - 191
• Main Authors: Libenson, Mark H, Kaye, Edward M, Rosman, N.Paul, Gilmore, Herbert E
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1999; Elsevier
• Subjects: Acetazolamide - adverse effects; Acetazolamide - therapeutic use; Biological and medical sciences; Cerebral Hemorrhage - classification; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - diagnostic imaging; Cerebrospinal Fluid Shunts; Diuretics - therapeutic use; Drainage; Drug Therapy, Combination; Female; Furosemide - adverse effects; Furosemide - therapeutic use; Humans; Hydrocephalus - etiology; Hydrocephalus - therapy; Infant, Newborn; Infant, Premature, Diseases - therapy; Kidney Calculi - chemically induced; Male; Medical sciences; Miscellaneous; Neuropharmacology; Pharmacology. Drug treatments; Spinal Puncture; Treatment Outcome; Ultrasonography; Sulfanilamide derivatives; Nephrocalcinosis; Toxicity; Acetazolamide; Cardiovascular disease; Lyases; Hemorrhage; Vascular disease; Diuretic; Complication; Hydrocephaly; Cerebrovascular disease; Human; Kidney disease; Nervous system diseases; Drug combination; Urinary system disease; Sulfonamide; Enzyme; Intracranial hypertension; Enzyme inhibitor; Cerebral ventricle; Furosemide; Urinary stone; Cerebral disorder; Chemotherapy; Newborn; Treatment; Central nervous system disease; Carbonate dehydratase; Carbon-oxygen lyases; Comparative study; Hydro-lyases
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/S0887-8994(98)00127-1

The authors evaluated the efficacy of acetazolamide (ACZ) and furosemide (FUR) in avoiding ventricular shunting procedures in preterm infants with posthemorrhagic hydrocephalus (PHH) and increased intracranial pressure (ICP). Preterm infants were screened for PHH (defined as ventriculomegaly [VM] and increased ICP measured with the Ladd fiberoptic monitor). PHH infants were randomized to ACZ and FUR treatment or serial lumbar puncture (LP) and monitored until not receiving medications or having undergone shunting. Of 69 infants with IVH screened for the study, 39 never developed VM, 14 developed VM, without increased ICP, and 16 developed PHH. Ten PHH infants were randomized to ACZ and FUR treatment and six to serial LP. Nine (90%) of the 10 infants assigned to the ACZ and FUR group avoided shunting. Nephrocalcinosis developed in a significant proportion of treated infants. Three (50%) of the six LP group infants did not require shunting procedures ( P = 0.118). The authors conclude that ACZ and FUR therapy is useful in the treatment of preterm infants with PHH. Because a significant number of infants treated with both ACZ and FUR developed nephrocalcinosis, close monitoring for increased calcium excretion in the urine, or use of ACZ without FUR, is advised.