Brain Injury in the Preterm Infant

Back, Stephen A.; Miller, Steven P.

doi:10.1016/b978-0-323-40139-5.00060-7

Cited by 4 publications

(1 citation statement)

References 234 publications

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“…GMH involves the rupture of blood vessels in the germinal matrix, a specialised brain area during development rich in neurons and glia. GMH occurs mostly in the first few days after birth in preterm infants, with 50% within 6h of birth [ 2 ]. The pathophysiology of GMH is still somewhat unclear but is thought to be multifactorial.…”

Section: Introductionmentioning

confidence: 99%

Function and Biomarkers of the Blood-Brain Barrier in a Neonatal Germinal Matrix Haemorrhage Model

Andersson

Rocha‐Ferreira

Hagberg

et al. 2021

Cells

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Germinal matrix haemorrhage (GMH), caused by rupturing blood vessels in the germinal matrix, is a prevalent driver of preterm brain injuries and death. Our group recently developed a model simulating GMH using intrastriatal injections of collagenase in 5-day-old rats, which corresponds to the brain development of human preterm infants. This study aimed to define changes to the blood-brain barrier (BBB) and to evaluate BBB proteins as biomarkers in this GMH model. Regional BBB functions were investigated using blood to brain 14C-sucrose uptake as well as using biotinylated BBB tracers. Blood plasma and cerebrospinal fluids were collected at various times after GMH and analysed with ELISA for OCLN and CLDN5. The immunoreactivity of BBB proteins was assessed in brain sections. Tracer experiments showed that GMH produced a defined region surrounding the hematoma where many vessels lost their integrity. This region expanded for at least 6 h following GMH, thereafter resolution of both hematoma and re-establishment of BBB function occurred. The sucrose experiment indicated that regions somewhat more distant to the hematoma also exhibited BBB dysfunction; however, BBB function was normalised within 5 days of GMH. This shows that GMH leads to a temporal dysfunction in the BBB that may be important in pathological processes as well as in connection to therapeutic interventions. We detected an increase of tight-junction proteins in both CSF and plasma after GMH making them potential biomarkers for GMH.

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Section: Introductionmentioning

confidence: 99%

Function and Biomarkers of the Blood-Brain Barrier in a Neonatal Germinal Matrix Haemorrhage Model

Andersson

Rocha‐Ferreira

Hagberg

et al. 2021

Cells

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Reducing Germinal Matrix-Intraventricular Hemorrhage: Perinatal and Delivery Room Factors

Lim

Hagen

2019

NeoReviews

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Much research has gone into understanding the pathogenesis and prevention of germinal matrix hemorrhage-intraventricular hemorrhage (IVH). Based on the current evidence, it is widely accepted that antenatal corticosteroid administration has helped reduce the risk of IVH in preterm infants. With continued identification of maternal interventions that can be implemented during the perinatal period, we hope to see a reduction in IVH rates. Almost half of all IVH occurs within the first day after birth, so understanding delivery room interventions that reduce IVH risk will hopefully contribute to further the ongoing efforts on reduction. At this time, prevention of premature birth continues to have the single greatest impact on reducing the incidence of germinal matrix hemorrhage-IVH.

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Reduction of Severe Intraventricular Hemorrhage in Preterm Infants: A Quality Improvement Project

et al. 2022

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OBJECTIVES: The aim of this quality improvement project was to reduce the rate of severe intraventricular hemorrhage (sIVH) by 50% within 3 years for extremely preterm infants born at a children’s teaching hospital. METHODS: A multidisciplinary team developed key drivers for the development of intraventricular hemorrhage in preterm infants. Targeted interventions included the development of potentially better practice guidelines, promoting early noninvasive ventilation, consistent use of rescue antenatal betamethasone, and risk-based indomethacin prophylaxis. The outcome measure was the rate of sIVH. Process measures included the rate of intubation within 24 hours and receipt of rescue betamethasone and risk-based indomethacin prophylaxis. Common markers of morbidity were balancing measures. Data were collected from a quarterly chart review and analyzed with statistical process control charts. The preintervention period was from January 2012 to March 2016, implementation period was from April 2016 to December 2018, and sustainment period was through June 2020. RESULTS: During the study period, there were 268 inborn neonates born at <28 weeks’ gestation or <1000 g (127 preintervention and 141 postintervention). The rate of sIVH decreased from 14% to 1.2%, with sustained improvement over 2 and a half years. Mortality also decreased by 50% during the same time period. This was associated with adherence to process measures and no change in balancing measures. CONCLUSIONS: A multipronged quality improvement approach to intraventricular hemorrhage prevention, including evidence-based practice guidelines, consistent receipt of rescue betamethasone and indomethacin prophylaxis, and decreasing early intubation was associated with a sustained reduction in sIVH in extremely preterm infants.

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Brain Injury in the Preterm Infant

Cited by 4 publications

References 234 publications

Function and Biomarkers of the Blood-Brain Barrier in a Neonatal Germinal Matrix Haemorrhage Model

Function and Biomarkers of the Blood-Brain Barrier in a Neonatal Germinal Matrix Haemorrhage Model

Reducing Germinal Matrix-Intraventricular Hemorrhage: Perinatal and Delivery Room Factors

Reduction of Severe Intraventricular Hemorrhage in Preterm Infants: A Quality Improvement Project

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