Introduction Intraventricular haemorrhage (IVH), which occurs in about 25 % of premature infants weighing less than 1500 g at birth, is rare in full-term neonates, but in these babies it has a worse outcome [1]. Term babies affected by major IVH exhibit severe neurological symptoms (ir- ritability, seizures, signs of increased intracranial pres- sure (ICP), stupor and coma) and a 50 % incidence of hypertensive post-haemorrhagic hydrocephalus. Management of neonatal hypertensive post-haemor- rhagic hydrocephalus is difficult and controversial [1], and long-term follow-up studies have shown a high per- centage of neurological sequelae in survivors [1]. Intra- ventricular infusion of streptokinase or tissue plasmino- gen activator has been proposed in preterm neonates who develop progressive ventriculomegaly after IVH, in an attempt to prevent hypertensive post-haemorrhag- ic hydrocephalus [2, 3]. We describe the case of a 10-day-old neonate with acute post-haemorrhagic hydrocephalus, due to an IVH and thalamic haemorrhage, who did not improve after emergency external ventricular drainage because of clots completely filling the ventricles and obstructing the catheter. Reliable cerebrospinal fluid (CSF) drain- age was obtained only after a fibrinolytic intraventricu- lar infusion had been started, with relief of ICP and re- lated symptoms. Case report A female was born in an uncomplicated vaginal delivery at 40 weeks' gestational age after an uneventful pregnancy of a 33- year-old mother. The Apgar score was 8 and 9 at 1 and 5 min, re- spectively. The baby weighed 3790 g at birth and had a normal neonatal course. She was discharged at 3 days of life. One week later she was admitted to our pediatric intensive care unit because of a sudden episode of hypertonia, seizures, clinical signs of ICP R. Luciano L. Tortorolo A. Chiaretti M. Piastra F. Velardi G. Polidori Intraventricular streptokinase infusion in acute post-haemorrhagic hydrocephalus Received: 8 April 1997 Accepted: 16 December 1997 R. Luciano ( ) ) × L. Tortorolo × A. Chiaretti M. Piastra × G. Polidori Institute of Pediatrics, Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy Tel.: + 39 (6) 30 15 43 48, 43 47 Fax: + 39 (6) 3 05 53 01 F. Velardi Institute of Neurosurgery, Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy Abstract Neonatal post-haemor- rhagic hydrocephalus is a clinical condition with a high mortality and long-term morbidity. Its clinical management is difficult and not well standardized. We describe the case of a term baby suffering from acute intracranial hypertension caused by an intraventricular and thalamic haemorrhage. In this case, the ex- ternal ventricular drain inserted to control intracranial pressure was in- effective because of repeated ob- structions due to blood clots. Con- tinuous intraventricular infusion of streptokinase of 20 000 U/day al- lowed quick lysis of the clots, drain- age of the cerebrospinal fluid and relief from the coma. Although it did not prevent a permanent ventri- culoperitoneal shunt, we obtained reabsorption of the intraventricular haemorrhage without rebleeding complications. We suggest the use of low-dose fibrinolytic infusion through an external drain for the treatment of acute intracranial hy- pertension following intraventricu- lar haemorrhage in term infants. Key words Intraventricular haemorrhage × Post-haemorrhagic hydrocephalus × Term infants × Streptokinase intraventricular infusion Intensive Care Med (1998) 24: 526±529 Ó Springer-Verlag 1998 BRIEF REPORT