Pathogenesis and Prevention of Intraventricular Hemorrhage

Abstract

SYNOPSIS Intraventricular hemorrhage (IVH) is a major neurological complication of prematurity. Pathogenesis of intraventricular hemorrhage is attributed to intrinsic fragility of germinal matrix vasculature and to the fluctuation in the cerebral blood flow. Germinal matrix exhibits rapid angiogenesis orchestrating formation of immature vessels. The angiogenic vessels lack pericytes, display immature basal lamina low in fibronectin, and have astrocyte end-feet coverage deficient in glial fibrillary acidic protein. These factors contribute to the fragility of the germinal matrix vasculature. Fluctuation in the cerebral blood flow results from a wide range of respiratory and hemodynamic instability associated with the preterm infants. Prenatal glucocorticoid exposure remains the most effective means of preventing IVH. Therapies targeted to enhance the stability of the germinal matrix vasculature and minimize fluctuation in the cerebral blood flow might lead to more effective strategies in preventing IVH.

Prevalence of and risk factors for cranial ultrasound abnormalities in very-low-birth-weight infants at Charlotte Maxeke Johannesburg Academic Hospital

“…Contrary to other studies, which showed a decrease in IVH with antenatal steroids, our study did not show a significant difference between the use of antenatal steroids in the case and control groups. [3] This may be due to the fact that the administration of antenatal steroids in our setting was lower than in other settings. Only 43% of mothers of VLBW infants had received steroids compared with 83.5% of those in the VON during the same period, which may have been due to late presentation of unbooked mothers.…”

“…Mechanical ventilation and PDA also had an increased association with IVH and this can be explained by fluctuations in cerebral blood flow. [3] The prevalence of IVH in inborn patients was less compared with those who were outborn, and there are many factors that could explain the higher risk, including delay in transfer, inadequate monitoring, and lack of appropriate management at referring centres. Contrary to other studies, which showed a decrease in IVH with antenatal steroids, our study did not show a significant difference between the use of antenatal steroids in the case and control groups.…”

“…Risk factors for IVH include low birth weight (LBW), gestational age (GA), prematurity, lack of antenatal steroids, asphyxia, prolonged labour, respiratory distress syndrome, recurrent tracheal suctioning, hypoxia, hypercarbia, acidosis, patent ductus arteriosus (PDA), rapid infusion of sodium bicarbonate and interhospital transfer. [3] Preterm infants with cPVL, without IVH, appear to have a different risk pattern, although the pathogenesis does involve both hypoxic-ischaemic and haemorrhagic processes. It also appears that intrauterine inflammation and cytokine release result in oxidative stress to white matter.…”

Riesgo neurológico en el niño de mediano riesgo neonatal

“…26 El cráneo fácilmente deformable, sobre todo en el bebé prematuro, puede elevar la presión venosa durante el parto vaginal, llevando a la idea que el parto por cesárea podría reducir estas complicaciones. No obstante, la evidencia parece indicar que la evitación del parto vaginal no confiere ninguna ventaja para el feto prematuro con pre-sentación cefálica, ni jugar un rol significativo en el deterioro del neurodesarrollo en neonatos de bajo y muy bajo peso al nacer.…”

Prevalência de hemorragia peri-intraventricular em recém‑nascidos de muito baixo peso e/ou com idade gestacional menor que 34 semanas e relação com o uso antenatal de corticoide e de sulfato de magnésio em maternidade terciária

“…2 Cerca de 50-75% dos prematuros com HPIV desenvolveram paralisia cerebral, retardo mental e/ desenvolveram distúrbios psiquiátricos. 3 e das HPIV, esta quase exclusiva em pré-termos, contribuem prematuros. Essas hemorragias, tanto intraparenquimatosas de vários fatores, entre eles: maior vulnerabilidade dos vasos o surgimento dessa patologia em crianças a termo, cujos nesses pacientes.…”