Circulatory Management Focusing on Preventing Intraventricular Hemorrhage and Pulmonary Hemorrhage in Preterm Infants

Abstract

The goal of modern neonatal care of extremely preterm infants is to reduce mortality and long-term neurological impairments. Preterm infants frequently experience cerebral intraventricular or pulmonary hemorrhage, which usually occurs within 72 hours after birth and can lead to long-term neurological sequelae and mortality. These serious hemorrhagic complications are closely related to perinatal hemodynamic changes, including an increase in the afterload on the left ventricle of the heart after the infant is separated from the placenta, and an increased preload from a left-to-right shunt caused by a hemodynamically significant patent ductus arteriosus (PDA). The left ventricle of a preterm myocardium has limited ability to respond to such an increase in afterload and preload, and this can result in cardiac dysfunction and hemodynamic deterioration. We suggest that delayed umbilical cord clamping or umbilical cord milking to maintain optimal blood pressure and systemic blood flow (SBF), careful assessment to keep the afterload at an acceptable level, and a strategy of early targeted treatment of significant PDA to improve perfusion during this critical time period may reduce or prevent these serious complications in preterm infants.

Birth Size and Gestational Age Specific Outcomes of Inhaled Nitric Oxide Therapy in Preterm Neonates with Clinically Diagnosed Pulmonary Hypertension

“…[56][57][58][59][60][61][62] Thus, while for some patients, the vasodilator effect of iNO might improve pulmonary blood flow, 36,[63][64][65][66] others may suffer detrimental effects of excessive left-to-right shunting through the patent ductus arteriosus ([PDA] e.g., pulmonary edema and/or pulmonary hemorrhage, especially among patients with pulmonary venous hypertension). 67 This phenotypic variability may underlie the apparently null effect of iNO in extremely premature neonates, as reported by others and our group in this study. 12,[14][15][16][17]19,22,28,29,34,68 In our primary analysis, we found that LGA infants with clinically diagnosed PH may derive a therapeutic benefit from iNO supports prior studies.…”

Perinatal risk factors for pulmonary hemorrhage in extremely low-birth-weight infants

“…PH may occur as a result of unstable hemodynamics and coagulopathy in ELBWIs with EOS. It has been proven that delayed cord clamping reduces the risk of PH [13]. Circulatory stabilization is the fundamental management strategy for ELBWIs and reduces the risk not only for pulmonary disease but also of mortality and IVH.…”

Preterm Pulmonary Hemorrhage Is Associated with Multiple Births but Not with Intracytoplasmic Sperm Injection: A Cohort Study on Medical Records

“…Previous publications have discussed the relevance of a changed blood circulation, especially of an increased afterload, in the occurrence of pulmonary hemorrhage. 14,15 However, explanations based on different blood circulation models in (monochorionic) multiples are purely speculative and would require further investigation.…”