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Periventricular- intraventricular hemorrhage in the premature infant- A historical perspective
1Department of Pediatrics, Weill Cornell Medicine, Division Chief of Newborn Medicine, New York Presbyterian Hospital, 1283 York Avenue 15(th) Floor, New York, NY, 10065.
Insights
Intraventricular hemorrhage in premature infants is linked to germinal matrix fragility and cerebral blood flow changes. Understanding these factors and implementing preventative strategies like antenatal steroids and indomethacin can reduce bleeding risk.
Area of Science:
- Neonatalogy
- Neurology
- Pediatrics
Background:
- Intraventricular hemorrhage (IVH) is a significant concern in premature infants.
- The germinal matrix is a vulnerable site for bleeding in the premature brain.
- Cerebral blood flow dynamics play a crucial role in IVH development.
Purpose of the Study:
- To trace the historical evolution of understanding intraventricular hemorrhage in premature infants.
- To highlight the role of the germinal matrix and cerebral blood flow in IVH.
- To review clinical factors and preventative strategies for IVH.
Main Methods:
- Review of neuropathological studies identifying germinal matrix capillary rupture.
- Introduction and utilization of cranial ultrasound for IVH diagnosis.
- Demonstration of impaired cerebral autoregulation and cerebral blood flow velocity fluctuations.
Main Results:
- Neuropathological studies in 1976 identified germinal matrix capillary rupture as the precursor.
- Cranial ultrasound, introduced in 1980, improved IVH diagnosis.
- Studies in the 1980s and 1990s elucidated the importance of cerebral blood flow changes and intravascular factors.
- Antenatal steroid use (1994) and early indomethacin administration (mid-1990s) showed reductions in IVH.
Conclusions:
- Understanding the pathogenesis of IVH has evolved significantly.
- Cerebral blood flow regulation and intravascular factors are critical in IVH genesis.
- Preventative strategies, including antenatal steroids and indomethacin, have demonstrated efficacy in reducing IVH.
Abstract:
The objective of this chapter is to trace the evolution of intraventricular hemorrhage in the premature infant highlighting the importance of the germinal matrix, a critical role for cerebral blood flow changes in the genesis of hemorrhage, clinical factors that increase the bleeding risk, and potential preventative strategies. In 1976, neuropathological studies demonstrated capillary rupture within the germinal matrix as the precursor of hemorrhage. In 1980, introduction of cranial ultrasound facilitated diagnosis of intraventricular hemorrhage. In 1979, loss of cerebral autoregulation in sick newborn infants was demonstrated. In the 1980's, studies demonstrated the importance of intravascular factors in provoking hemorrhage. In 1983, the association of cerebral blood flow velocity fluctuations and subsequent hemorrhage was demonstrated. In 1994, antenatal steroids use to accelerate lung development was recommended. This was associated with an unanticipated reduction in hemorrhage. In the mid 1990's early indomethacin administration was associated with a reduction of severe hemorrhage.
