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Intraventricular hemorrhage in extremely low birth weight infants: frequency and duration of impaired cerebrovascular

Howard Chao1, Sebastian Acosta2, Craig Rusin2

  • 1Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. howard.chao@bcm.edu.

Pediatric Research
|December 22, 2025
PubMed

Insights

Extremely low birth weight (ELBW) infants with intraventricular hemorrhage (IVH) showed more frequent and longer periods of impaired cerebrovascular reactivity. This highlights TOHRx as a potential early indicator for monitoring brain health in ELBW infants.

Area of Science:

  • Neonatal neuroscience
  • Cerebrovascular physiology
  • Medical monitoring technologies

Background:

  • Extremely low birth weight (ELBW) infants exhibit limited cerebral autoregulation, increasing risk for intraventricular hemorrhage (IVH).
  • Hemodynamic instability during the postnatal period is a critical concern for ELBW infants.

Purpose of the Study:

  • To investigate the association between impaired cerebrovascular reactivity and IVH development in ELBW infants.
  • To determine if the frequency and duration of abnormal cerebral blood flow regulation predict IVH in the first 72 postnatal hours.

Main Methods:

  • Near-infrared spectroscopy (NIRS) was used for continuous regional cerebral oximetry monitoring.
  • The tissue oxygenation-heart rate reactivity index (TOHRx) was calculated and analyzed for positive and negative periods.
  • Study included preterm infants (401-1000g birth weight) within the first 72 hours of life.

Main Results:

  • Infants who developed IVH exhibited predominantly positive TOHRx values, unlike those without IVH.
  • A higher frequency and longer duration of positive TOHRx measurements were observed in infants with IVH.
  • High-grade IVH (Grade 3-4) correlated with predominantly positive TOHRx values.

Conclusions:

  • ELBW infants with IVH demonstrate more frequent and prolonged episodes of impaired cerebrovascular reactivity.
  • The TOHRx index shows potential as an early marker for cerebrovascular health in ELBW infants.
  • Findings underscore the importance of monitoring cerebral autoregulation to potentially reduce IVH incidence and severity.
Abstract

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