Intraventricular hemorrhage and hydrocephalus in premature newborns: a prospective study with CT

Severe intra- and periventricular hemorrhage: role of arteriolosclerosis related to maternal smoke

“…These alterations can be traced to the toxic effects of the gaseous components of nicotine, as also demonstrated in large-caliber arteries, arterioles, and in the arteries of adnexa [18,20,21]. In addition to the direct hemodynamic effects, toxic effects of the gaseous components released during the combustion of nicotine have been shown to damage the arterial wall [15,27].…”

“…Although the IV-PVH, particularly its association with perinatal factors, has been a subject of several studies [18][19][20][21][22][23], the cause of this pathology has not yet been explained. An important causal factor is represented by cigarette smoke.…”

“…Instead, fetal/neonatal conditions include: immature vessels of the germinal matrix and autoregulation failure of cerebral blood flow in premature, congenital factor X and factor V deficiencies, hypoxia-acidosis, twin-twin transfusion, demise of a cotwin, or fetomaternal hemorrhage [4,21,24,25]. The hemorrhage starts in the germinal matrix which is a structure located beneath the ependymal lining, usually between the head of caudate nucleus, adjacent to the foramina of Monroe and the thalamus [18]. This area has a high vascularity and its immature fragile capillary network with poor stromal support, and the sharp "U-turn" the thalamostriate veins, makes the germinal matrix prone to congestion [19].…”

“…Indeed, this area is a source of both neurons and glial cells during the development of the fetal brain. It is most active between 24 and 32 weeks gestation, then it involutes till 35 weeks and it is much smaller in fullterm infants than prematures [18].…”

“…The prognosis and the neurological sequelae are usually related to the severity of the hemorrhage, according to the classification of Papile [18]. Grades 1 and 2 are considered mild and have minimal long-term neurological sequelae; grades 3 and 4 are predictive of severe outcome such as seizures, blindness, mental retardation, cerebral palsy, and death [20,21].…”