Hemodynamic and Antecedent Risk Factors of Early and Late Periventricular/Intraventricular Hemorrhage in Premature Infants

Osborn, David A; Evans, Nick; Kluckow, Martin

doi:10.1542/peds.112.1.33

Cited by 249 publications

(228 citation statements)

References 35 publications

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“…26 The association between vaginal delivery and IVH is controversial. [26][27][28][29][30] In this case-control study, we found that vaginal delivery was a risk factor for severe IVH. Low superior vena cava flow, resulting from the inability of the immature heart to withstand high systemic resistance after birth, is associated with an increased risk of late IVH.…”

Section: Discussionmentioning

confidence: 68%

“…Low superior vena cava flow, resulting from the inability of the immature heart to withstand high systemic resistance after birth, is associated with an increased risk of late IVH. 30,31 As the majority of hemorrhages develop after the improvement of the superior vena cava flow, hypoperfusion-reperfusion injury was assumed to be the cause of late IVH. In contrast, normal superior vena cava flow was observed among babies with early IVH; hence, it is believed that the hypoperfusion-reperfusion cycle occurred earlier.…”

Section: Discussionmentioning

confidence: 99%

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Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants

et al. 2010

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Objective: To identify the risk factors contributing to intraventricular hemorrhage (IVH) in extremely low birth weight infants during early postnatal life, after appropriate matching for gestational age (GA) and birth body weight (BBW).Study Design: A case-control retrospective study was designed to evaluate preterm infants with a GA p26 weeks and a BBW p1000 g admitted to our hospital during a 7.5-year period. From a cohort of 347 preterm infants, 36 infants (10.7%) had severe IVH (grades III and/or IV). We selected a control group of 36 preterm infants without IVH who were closely matched for GA ( ± 1 week) and body weight ( ± 100 g). Univariate and multivariate logistic regression analyses were performed to identify risk factors for severe IVH. Result:The GA and BBW of the IVH and control groups were 24.6 ± 1weeks and 764.4 ± 118.5 g, and 24.8 ± 0.9 weeks and 771.5 ± 125.9 g, respectively. Vaginal delivery, male sex, resuscitation in the delivery room, high sodium serum levels (meq l À1 ) (162.6 vs 148.8), fluctuation of serum sodium (meq l À1 ) (17.3 vs 6.2), pH, PaCO 2 , hemoglobin and platelet counts were associated with an increased risk of severe IVH. Multivariate logistic regression indicated that sodium fluctuations >13 meq l À1 , vaginal delivery, male sex and hemoglobin fluctuations are strongly associated with the development of severe IVH.Conclusion: Hypernatremia and fluctuations of sodium seem to be related to early severe IVH among preterm infants; however, further studies are required to clarify the causal relationship.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants

et al. 2010

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“…At the time the autoregulation studies were conducted, 11 infants were being administered cardiovascular medications due to circulatory impairment and 27 were placed on invasive mechanical ventilation. The serial echocardiography assessment showed that 9 of the 54 infants had SVC flow below the cut-off value of 41 ml/kg per min (defined as low SVC flow) (7)(8)(9) at some point during the study. During the observation period, the SVC flow measurement closest to a given epoch was recorded.…”

Section: Mechanistic Approach In Autoregulationmentioning

confidence: 99%

New developments in cerebral blood flow autoregulation analysis in preterm infants: a mechanistic approach

Riera

Cabañas

Olmedo³

et al. 2015

Pediatr Res

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Background: Impaired autoregulation capacity implies that changes in cerebral perfusion follow changes in blood pressure; however, no analytical method has explored such a signal causality relationship in infants. We sought to develop a method to assess cerebral autoregulation from a mechanistic point of view and explored the predictive capacity of the method to classify infants at risk for adverse outcomes. Methods: The partial directed coherence (PDC) method, which considers synchronicity and directionality of signal dependence across frequencies, was used to analyze the relationship between spontaneous changes in mean arterial pressure (MAP) and the cerebral tissue oxygenation index (TOI). PDC MAP>>TOI indicated that changes in TOI were induced by MAP changes, and PDC TOI>>MAP indicated the opposite. results: The PDC MAP>>TOI and PDC TOI>>MAP values differed. PDC MAP>>TOI adjusted by gestational age predicted low superior vena cava flow (≤41 ml/kg per min), with an area under the receiver operating characteristic curve of 0.72 (95% CI: 0.63-0.81; P < 0.001), whereas PDC TOI>>MAP did not. The adjusted pPDC MAP>>TOI (the average value per patient) predicted severe intracranial hemorrhage and mortality. conclusion: PDC MAP>>TOI allows for a noninvasive physiological interpretation of the pressure autoregulation process in neonates. PDC MAP>>TOI is a good classifier for infants at risk of brain hypoperfusion and adverse outcomes.

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“…7 In some babies, SVC flow dropped to extremely low levels during this nadir, and these babies were particularly at a high risk of a range of adverse outcomes including, intraventricular hemorrhage (which seems to occur as SBF improves), death, necrotizing enterocolitis and a poor 3-year neurodevelopmental outcome. 4,[7][8][9] Data are now emerging from other groups that are duplicating some of these findings. 10 Most importantly, there is a very weak relationship between these measures of SBF and BP (Figure 3).…”

Section: Studies Of the Systemic Circulationmentioning

confidence: 99%

Support of the preterm circulation: Keynote Address to the Fifth Evidence vs Experience Conference, Chicago, June 2008

Evans

2009

J Perinatol

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Hemodynamics is an area of neonatology that is marked more by what we do not know than what we do. What is clear is that it is much more complex than just measuring blood pressure (BP). Early postnatal preterm hemodynamic pathophysiology is characterized by low systemic blood flow (SBF), possibly relating to a mix of afterload compromise, left-to-right shunting through the unconstricted ductus and to the circulatory effects of ventilation. After B24 h of age, vasodilatation seems to be the dominant pathology. In the face of this complexity, a one-size-fits-all approach to treatment that will be applicable in a large clinical trial may prove elusive. The possibility of using a measure of both BP and SBF to target an appropriate treatment needs to be explored.

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Hemodynamic and Antecedent Risk Factors of Early and Late Periventricular/Intraventricular Hemorrhage in Premature Infants

Abstract: Early and late P/IVH have distinct and different risk factors. Early P/IVH is associated with vaginal delivery and possibly low Apgar scores. Late P/IVH is associated with antecedent low SVC flow in the first day.

Cited by 249 publications

References 35 publications

Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants

Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants

New developments in cerebral blood flow autoregulation analysis in preterm infants: a mechanistic approach

Support of the preterm circulation: Keynote Address to the Fifth Evidence vs Experience Conference, Chicago, June 2008

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