The effectiveness of interventions to prevent intraventricular haemorrhage in premature infants: A systematic review and network meta-analysis

Yao, Si Liang; Smit, Elisa; Odd, David

doi:10.3233/npm-221048

Cited by 8 publications

(3 citation statements)

References 95 publications

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“…Kalani et al [ 50 ] discovered that early ibuprofen administration had a similar IVH-preventive effect. Two recent meta-analyses revealed that indomethacin prophylaxis was associated with a lower rate of severe IVH [ 1 , 125 ]. In contrast, several retrospective studies and clinical trials reported that prophylactic indomethacin not only demonstrated no IVH-preventive effect but also increased the risks of impaired renal function and bleeding tendency [ 61 , 72 , 82 ].…”

Section: Postnatal Strategymentioning

confidence: 99%

Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants

Tsao¹

2023

J Korean Neurosurg Soc

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Intraventricular haemorrhage (IVH) is a serious concern for preterm infants and can predispose such infants to brain injury and poor neurodevelopmental outcomes. IVH is particularly common in preterm infants. Although advances in obstetric management and neonatal care have led to a lower mortality rate for preterm infants with IVH, the IVH-related morbidity rate in this population remains high. Therefore, the present review investigated the pathophysiology of IVH and the evidence related to interventions for prevention. The analysis of the pathophysiology of IVH was conducted with a focus on the factors associated with cerebral hemodynamics, vulnerabilities in the structure of cerebral vessels, and host or genetic predisposing factors. The findings presented in the literature indicate that fluctuations in cerebral blood flow, the presence of hemodynamic significant patent ductus arteriosus, arterial carbon dioxide tension, and impaired cerebral venous drainage; a vulnerable or fragile capillary network; and a genetic variant associated with a mechanism underlying IVH development may lead to preterm infants developing IVH. Therefore, strategies focused on antenatal management, such as routine corticosteroid administration and magnesium sulfate use; perinatal management, such as maternal transfer to a specialized center; and postnatal management, including pharmacological agent administration and circulatory management involving prevention of extreme blood pressure, hemodynamic significant patent ductus arteriosus management, and optimization of cardiac function, can lower the likelihood of IVH development in preterm 4 infants. Incorporating neuroprotective care bundles into routine care for such infants may also reduce the likelihood of IVH development. The findings regarding the pathogenesis of IVH further indicate that cerebrovascular status and systemic hemodynamic changes must be analyzed and monitored in preterm infants and that individualized management strategies must be developed with consideration of the risk factors for and physiological status of each preterm infant.

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Section: Postnatal Strategymentioning

confidence: 99%

Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants

Tsao¹

2023

J Korean Neurosurg Soc

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“…IVH after preterm birth is a significant worldwide problem, and both IVH and PHVD are associated with significant increased mortality [ 5 ], and strongly influence decisions around limitation or withdrawal of care [ 6 ]. Reducing IVH and other perinatal brain injury is a key part of the UK National Maternity Ambition [ 7 ] and while a small number of interventions may reduce the risk [ 8 , 9 ], no effective treatment is currently available [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Quality of Life at a 10-Year Follow-Up of Children Born Preterm with Post-Hemorrhagic Ventricular Dilatation: A Cohort Study

Rela,

Jary,

Williams

et al. 2023

Neonatology

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Background: Post-haemorrhagic ventricular dilatation (PHVD) is commonly seen in extremely preterm babies, carries significant morbidity, and may cause neonatal mortality. There is a lack of literature on the subsequent health-related quality of life (HRQoL) in childhood. The aim of this work was to assess the quality of life of preterm babies after PHVD at 10 years of age using two validated questionnaires. Methods: Children with PHVD were assessed as part of the 10-year follow-up of the drainage, irrigation, and fibrinolytic therapy trial. The HRQoL outcome was measured using parent-reported EQ-5D-5L and HUI-3 questionnaires. Both questionnaires produce a summary score anchored at 1 (best health) and 0 (equivalent to death). Results: Median scores at follow-up were 0.65 (IQR 0.36–0.84; n = 44) for the EQ-5D-5L and 0.52 (IQR 0.22–0.87; n = 51) for the HUI-3. Similar proportions had a score below 0.2 (HRQoL [20%], HUI-3 [21%]), while 20% had a HRQoL score above 0.80 compared to 34% using HUI-3. The most severe problems from the EQ-5D-5L were reported in the self-care, mobility, and activity domains, while the HUI-3 reported worse problems in ambulation, cognition, and dexterity domains. Infants with worse (grade 4) intraventricular haemorrhage had poorer HRQoL than those with grade 3 bleeds. Conclusion: Children who survive to 10 years of age after PHVD have on average lower HRQoL than their peers. However, the reported range is wide, with a quarter of the children having scores above 0.87 (similar to population norms), while a fifth have very low HRQol scores. Impact was not uniform across domains, with mobility/ambulation a concern across both measures.

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“…These dynamics are critically modulated by “hemodynamically significant” changes in the degree of shunting of blood flow across the patent ductus arteriosus (PDA) ( 3 , 4 ). Adverse hemodynamic effects on IVH pathogenesis persist despite the common use of antenatal corticosteroids, delayed cord clamping, and indomethacin prophylaxis, which have each been shown to partly reduce the risk of IVH ( 5 ). Whether aggregate strategies that achieve greater hemodynamic stability in preterm infants by addressing specific physiologic targets can reduce the risk of severe IVH and other outcomes of prematurity has been uncertain.…”

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confidence: 99%