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Prevention of intraventricular hemorrhage in the premature infant
A M Abdel-Rahman1, A A Rosenberg
1Department of Pediatrics, University of Colorado School of Medicine, Denver.
Insights
Antenatal phenobarbital shows promise in reducing severe periventricular-intraventricular hemorrhage (PIVH) in preterm infants. Ongoing trials will confirm its efficacy and safety for preventing this common neonatal complication.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Neurology
Background:
- Periventricular-intraventricular hemorrhage (PIVH) remains a significant challenge in preterm infant care.
- While diagnostic tools have improved, severe PIVH outcomes are still unfavorable.
- The incidence of PIVH is declining, but prevention strategies require further investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of antenatal interventions for preventing PIVH.
- To assess the potential of phenobarbital as an antenatal treatment to reduce severe PIVH.
- To review existing evidence on antenatal phenobarbital trials for PIVH prevention.
Main Methods:
- Review of four reported antenatal phenobarbital trials.
- Analysis of diagnostic advancements like real-time ultrasonography and Doppler flow studies.
- Consideration of ongoing multicenter trials, such as the Neonatal Network trial.
Main Results:
- Four antenatal phenobarbital trials consistently demonstrated a decrease in severe PIVH.
- Despite varying study designs, results suggest efficacy and safety of antenatal phenobarbital.
- A significant portion of PIVH occurs during the perinatal period, supporting antenatal intervention.
Conclusions:
- Antenatal phenobarbital is a promising intervention for reducing severe PIVH in preterm infants.
- The consistency across trials supports the efficacy and safety of this approach.
- Further definitive results are expected from ongoing large-scale trials.
Abstract:
PIVH remains a significant problem in the care of the preterm infant. Recent technologic advances such as real-time ultrasonography and Doppler flow studies have facilitated accurate diagnosis and provided insight into the pathogenesis. Although the overall incidence of PIVH is declining, the outcome of survivors of PIVH--especially those with more severe grades--remains unfavorable. Several antenatal and postnatal interventions aimed at reducing the overall incidence and severity of PIVH have been attempted. Antenatal interventions, in particular phenobarbital, appear to be promising because a substantial percentage of PIVH occurs in the immediate perinatal period. It is significant that the four reported antenatal phenobarbital trials demonstrated a consistent decrease in severe PIVH. Despite the fact that these studies have different designs and each must be considered on its own, the consistency of results makes a strong statement regarding efficacy and safety. The on-going multicenter Neonatal Network trial should provide definitive results as to the efficacy and safety of antenatal phenobarbital in the prevention of PIVH.