Abstract
The etiology of intraventricular hemorrhage (IVH) in extremely low birth weight preterm infants is multifactorial with circulatory instability and hemostasis being preeminent. This study sought to determine if the germinal matrix layer remained intact when platelets were above 200 × 109/L, a near normal level, and fell below that when IVH occurred. This was a retrospective study of platelets and head ultrasounds (HUS) in infants 23–28 weeks gestation. Analyses were descriptive, one way analysis of variance, Pearson Chi-square tests, and t-tests. Platelet counts and HUS were linked in 114 infants during the first 3 days when 90% of IVHs occur. Mean platelet levels were >200 × 109/L in 68% of infant 23–24 weeks gestation and 78% of those 25–26 weeks when there were no IVHs. These findings, if confirmed, suggest that improving hemostasis in high risk preterm infants by keeping platelet levels >200 × 109/L may maintain the integrity of the germinal matrix layer and prevent IVHs.
Highlights
The etiology of intraventricular hemorrhage (IVH) is multifactorial with prematurity, circulatory instability, and hemostasis being preeminent [1, 2]
We focused on clinical data available during the first 3 days since 90% of IVH occur during that time [1]
Forty additional infants were not included in the analysis because their mothers had pregnancy-associated hypertension (PIH), which is known to lower platelet numbers
Summary
The etiology of intraventricular hemorrhage (IVH) is multifactorial with prematurity, circulatory instability, and hemostasis being preeminent [1, 2]. The presence of germinal matrix and its fragile vessels in the ganglion eminence makes the immature brain exceptionally vulnerable to hemorrhage, especially IVH [3]. IVH could be prevented by limiting germinal matrix layer hemorrhages (GMH) from enlarging and rupturing into the cerebral ventricles (Figure 1). Studies have suggested that extremely low birth weight (ELBW) infants may not be able to accomplish this because of their innately limited hemostatic capacity [4,5,6]. One facet of their coagulation system that is not limited, is the concentration of circulating platelets. Accepted mean and median platelet levels in ELBW infants at birth are greater than 200 × 109/L [7,8,9,10,11]
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