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Intraventricular haemorrhage in preterm infants--can we improve outcome by addressing coagulation?
Amir A Kuperman1,2, Benjamin Brenner3,4, Gili Kenet5,6
1a Pediatric Hematology Clinic, Thrombosis and Hemostasis Service, Institute of Hematology, Western Galilee Hospital , Naharriya , Israel .
Insights
Intraventricular Hemorrhage (IVH) in preterm infants is a significant concern. Studies reviewed interventions targeting the premature coagulation system to reduce IVH, a major cause of disability.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Hematology
Background:
- Increasing survival rates of preterm infants have led to a rise in morbidity, particularly Intraventricular Hemorrhage (IVH).
- IVH is a significant complication of preterm birth, especially in very low birth weight infants, and can lead to long-term disability.
- Prematurity and low birth weight are key risk factors for IVH, impacting the germinal matrix and coagulation system.
Purpose of the Study:
- To review the outcomes of interventional studies targeting the premature coagulation system.
- To evaluate the effectiveness of various treatments in preventing or reducing IVH in preterm neonates.
Main Methods:
- Review of small, open-label interventional studies.
- Analysis of interventions including ethamsylate, vitamin K, fresh frozen plasma, recombinant activated factor VII, and prothrombin complex concentrate.
- Focus on studies addressing coagulation deficiencies in preterm newborns.
Main Results:
- Approximately 80% of IVHs occur within 72 hours of birth, with some visible on initial ultrasounds.
- Coagulation deficiency is hypothesized as a major contributing factor to IVH.
- Outcomes of interventions targeting the coagulation system are presented for review.
Conclusions:
- Intraventricular Hemorrhage (IVH) remains a critical issue in preterm infant care.
- Targeting the coagulation system presents a potential therapeutic strategy for IVH prevention.
- Further research and review of interventional outcomes are necessary to optimize management.
Abstract:
During the last few decades, the survival of preterm infants has increased dramatically. Nevertheless, with the increasing number of very young and extremely low birth weight infants, morbidity is still a major problem. Intraventricular Haemorrhage (IVH) is a major complication of preterm birth, and large haemorrhages or haemorrhages associated with parenchymal brain lesions may yield a high rate of future disability. IVH is a complex, multi-factorial disorder. Prematurity and low birth weight remain as its most important risk factors, affecting vulnerability of the germinal matrix as well as the coagulation system. Approximately 80% of IVHs occur by 72 h after birth, but a considerable proportion of IVH is already visible on the first cranial ultrasound scan within a few hours of birth. The hypothesis that a severe coagulation deficiency in the premature newborn could be a major contributing factor to IVH has been suggested, and small open label interventional studies targeting the premature coagulation system have been conducted with ethamsylate, vitamin K, fresh frozen plasma, recombinant activated factor VII and prothrombin complex concentrate. The outcome of these studies will be reviewed.
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