Although the incidence of subependymal haemorrhage/intraventricular haemorrhage (IVH)/intraparenchymal haemorrhage has decreased in recent years, it remains a good predictor of neurodevelopmental handicaps in very-preterm infants.1 Intraventricular blood leakage can result in hydrocephalus due to limited cerebrospinal fluid resorption, a consequence of fibrosis in the arachnoid granulation, subependymal basal lamina and perivascular spaces. The reference treatment approved for hydrocephalus is the ventriculoperitoneal shunt. A randomised trial of an alternative treatment procedure combining drainage and intraventricular fibrinolysis with recombinant tissue plasminogen activator (rt-PA) has been stopped because of haemorrhagic complications.

t-PA binds to low-density lipoprotein (LDL)-related receptor protein-1 (LRP1) promoting the induction of matrix metalloproteinase (MMP) 9. In addition, t-PA cleavage of plasminogen initiates proteolytic MMP cascade, resulting in degradation of …