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Early Metabolic Alterations Are Associated with Intraventricular Hemorrhage and Its Complications in Very Preterm

Aviv Schupper1,2, Brian Reichman3,4, Inna Zaslavsky-Paltiel3,4

  • 1Pediatric Neurology and Development Center, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.

Neonatology
|June 9, 2026
PubMed

Insights

Early detection of intraventricular hemorrhage (IVH) in preterm infants is possible through metabolic profiling. Higher methionine and proline levels indicate increased IVH risk, while free carnitine suggests a protective effect.

Area of Science:

  • Neonatal neurology
  • Metabolomics
  • Pediatric critical care

Background:

  • Intraventricular hemorrhage (IVH) and its complications, PVHI and PHVD, are significant concerns in very preterm infants.
  • Early identification of risk factors is crucial for timely intervention.

Purpose of the Study:

  • To identify early metabolic alterations associated with IVH and its complications in very preterm infants.
  • To investigate the relationship between specific metabolites and the risk of IVH.

Main Methods:

  • A population-based cohort of 7,313 preterm infants (24-32 weeks' gestation) was analyzed.
  • Twenty-one metabolites were quantified from dried blood spots using tandem mass spectrometry within 96 hours of birth.
  • Multivariable logistic regression examined associations between metabolite concentrations and IVH, stratified by complications.

Main Results:

  • Higher concentrations of methionine and proline were associated with increased odds of IVH (OR 1.50-1.74).
  • Higher concentrations of free carnitine were associated with significantly lower odds of IVH (OR 0.53).
  • These associations were more pronounced in infants with PVHI and PHVD.

Conclusions:

  • Elevated methionine and proline levels in early life are linked to higher IVH risk in preterm infants.
  • Higher free carnitine levels appear protective against IVH in this population.
  • Further research is needed to determine if these metabolic changes are causes or consequences of brain injury.
Abstract

Keywords:
BiomarkersCarnitinePeriventricular hemorrhagic infarctionPosthemorrhagic hydrocephalusPosthemorrhagic ventricular dilatation

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