Cargando…

Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants

Intraventricular hemorrhage (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 ra...

Descripción completa

Detalles Bibliográficos
Autor principal: Tsao, Pei-Chen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Neurosurgical Society 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10183267/
https://www.ncbi.nlm.nih.gov/pubmed/36919227
http://dx.doi.org/10.3340/jkns.2022.0288
_version_ 1785041919335727104
author Tsao, Pei-Chen
author_facet Tsao, Pei-Chen
author_sort Tsao, Pei-Chen
collection PubMed
description Intraventricular hemorrhage (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 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.
format Online
Article
Text
id pubmed-10183267
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Korean Neurosurgical Society
record_format MEDLINE/PubMed
spelling pubmed-101832672023-05-15 Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants Tsao, Pei-Chen J Korean Neurosurg Soc Review Article Intraventricular hemorrhage (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 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. Korean Neurosurgical Society 2023-05 2023-03-15 /pmc/articles/PMC10183267/ /pubmed/36919227 http://dx.doi.org/10.3340/jkns.2022.0288 Text en Copyright © 2023 The Korean Neurosurgical Society https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Tsao, Pei-Chen
Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants
title Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants
title_full Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants
title_fullStr Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants
title_full_unstemmed Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants
title_short Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants
title_sort pathogenesis and prevention of intraventricular hemorrhage in preterm infants
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10183267/
https://www.ncbi.nlm.nih.gov/pubmed/36919227
http://dx.doi.org/10.3340/jkns.2022.0288
work_keys_str_mv AT tsaopeichen pathogenesisandpreventionofintraventricularhemorrhageinpreterminfants