Perinatal factors associated with severe intracranial hemorrhage

Thorp, James A.; Jones, Philip G.; Clark, Reese H.; Knox, Eric; Peabody, Joyce L.

doi:10.1067/mob.2001.117355

Cited by 59 publications

(48 citation statements)

References 16 publications

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“…We expressed the data as mean (SE) and analyzed for statistically significant differences by unpaired t-test. We used Pearson correlations and analyzed the differences between groups for each categorical variable with 2 and Fisher exact tests.…”

Section: Discussionmentioning

confidence: 99%

“…1 the most common variety of cerebral hemorrhage, affects ϳ15%-20% of preterm infants and therefore is a major concern in their care (1)(2)(3). Perinatal hypoxia is an important risk factor in the pathogenesis of IVH because it alters mechanisms that regulate cerebral blood flow and triggers a cascade of biochemical events that begins with a shift from oxidative to anaerobic metabolism and leads to oxidative brain damage resulting from excessive production of free radicals (4,5 ).…”

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confidence: 99%

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Increased Plasma Concentrations of Activin A Predict Intraventricular Hemorrhage in Preterm Newborns

et al. 2006

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Background: Intraventricular hemorrhage (IVH) is a major cause of neurologic disabilities in preterm newborns. We evaluated the use of plasma activin A concentrations to predict the development of perinatal IVH. Methods: We measured nucleated erythrocyte (NRBC) counts, plasma activin A, hypoxanthine (Hyp), and xanthine (Xan) in arterial blood samples obtained from 53 preterm infants during the first hour after birth. Cerebral ultrasound was performed within 48 h of birth and repeated at 5-or 6-day intervals until the age of 4 weeks. Results: Grade I or II IVH was detected during the first 10 days of life in 11 of 53 patients (21%). Activin A, Hyp, and Xan concentrations and NRBC counts were higher in preterm newborns who subsequently developed IVH than in those who did not (P <0.0001, except P ‫؍‬ 0.019 for Xan). Neonatal activin A was correlated (P <0.0001) with Hyp (r ‫؍‬ 0.95), Xan (r ‫؍‬ 0.90), and NRBC count (r ‫؍‬ 0.90) in newborns without later IVH and in those who developed IVH (Hyp, r ‫؍‬ 0.89, P ‫؍‬ 0.0002; Xan, r ‫؍‬ 0.95, P <0.0001; NRBC count, r ‫؍‬ 0.90, P ‫؍‬ 0.0002). At a cutoff of 0.8 g/L activin A, the sensitivity and specificity were 100% [11 of 11; 95% confidence interval (CI), 71%-100%] and 93% (39 of 42; 95% CI, 81%-98%), and positive and negative predictive values were 79% (95% CI, 61%-100%) and 0% (95% CI, 0%-2%), respectively. The area under the ROC curve was 0.98. Conclusions: Activin A concentrations at birth are increased in preterm newborns who later develop IVH

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Increased Plasma Concentrations of Activin A Predict Intraventricular Hemorrhage in Preterm Newborns

et al. 2006

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“…Intraventricular hemorrhage (IVH), a condition resulting from the rupture of the germinal matrix through the ependymal into the lateral ventricle, mainly occurs in premature infants 1, 2. The risk and severity of IVH directly correlate with degree of immaturity 3, and the improved survival of extremely preterm infants, enabled by recent advances in neonatal intensive care, has resulted in an increased number of preterm infants at high risk of developing severe IVH 4.…”

Section: Introductionmentioning

confidence: 99%

Mesenchymal Stem Cells for Severe Intraventricular Hemorrhage in Preterm Infants: Phase I Dose-Escalation Clinical Trial

Ahn

Chang

Sung

et al. 2018

Stem Cells Translational Medicine

126

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We previously demonstrated that transplanting mesenchymal stem cells (MSCs) improved recovery from brain injury induced by severe intraventricular hemorrhage (IVH) in newborn rats. To assess the safety and feasibility of MSCs in preterm infants with severe IVH, we performed a phase I dose‐escalation clinical trial. The first three patients received a low dose of MSCs (5 × 106 cells/kg), and the next six received a high dose (1 × 107 cells/kg). We assessed adverse outcomes, including mortality and the progress of posthemorrhagic hydrocephalus. Intraventricular transplantation of MSCs was performed in nine premature infants with mean gestational age of 26.1 ± 0.7 weeks and birth weight of 808 ± 85 g at 11.6 ± 0.9 postnatal days. Treatment with MSCs was well tolerated, and no patients showed serious adverse effects or dose‐limiting toxicities attributable to MSC transplantation. There was no mortality in IVH patients receiving MSCs. Infants who underwent shunt surgery showed a higher level of interleukin (IL)‐6 in cerebrospinal fluid (CSF) obtained before MSC transplantation in comparison with infants who did not receive a shunt. Levels of IL‐6 and tumor necrosis factor‐α in initially obtained CSF correlated significantly with baseline ventricular index. Intraventricular transplantation of allogeneic human UCB‐derived MSCs into preterm infants with severe IVH is safe and feasible, and warrants a larger, and controlled, phase II study. Stem Cells Translational Medicine 2018;7:847–856

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the adverse effects of cigarette smoking are related to chronic hypoxia from decreased uteroplacental perfusion. Besides, nicotine determines significant hemodynamic effects also in the mother by increasing arterial blood pressure and heart rate, which then cause increases of fetal arterial pressure and significant decrease of heart rate and umbilical blood flow [23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

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

2011

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Objective The authors aimed to describe the atherosclerotic lesions of the cerebral arterioles as a substrate of their rupture and bleeding. Methods The study was performed on the brain of nine Caucasian fetal victims of intra-and periventricular hemorrhage, all grade IV, and nine control cases. Results In the nine victims of hemorrhage, the arteriolar wall structure was altered, focally transformed into a deposit of amorphous eosinophilic material. Such changes often affected the full thickness of the wall causing rupture and hemorrhage. In eight of these cases and in two victims of the control group, the mothers were heavy cigarette smokers (15-20 cigarettes/day) before and during pregnancy. Conclusion The authors conclude that intra-and periventricular hemorrhage can be ascribed to the toxic effects of prenatal absorption of nicotine.

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Perinatal factors associated with severe intracranial hemorrhage

Cited by 59 publications

References 16 publications

Increased Plasma Concentrations of Activin A Predict Intraventricular Hemorrhage in Preterm Newborns

Increased Plasma Concentrations of Activin A Predict Intraventricular Hemorrhage in Preterm Newborns

Mesenchymal Stem Cells for Severe Intraventricular Hemorrhage in Preterm Infants: Phase I Dose-Escalation Clinical Trial

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

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