Intraventricular Hemorrhage Group Research Articles

Premature newborns with intraventricular hemorrhage do not have vasospasm pattern by cranial Doppler ultrasound: A pilot study.

Preterm neonates are at risk for neurodevelopmental impairment, especially those with intraventricular hemorrhage (IVH). Cerebral vasospasm (VSP) is a common complication after subarachnoid hemorrhage (SAH) in adult population, but it is unknown if preterm neonates with IVH may develop it. We prospectively enrolled premature newborns < 32weeks with IVH and without IVH. All patients received serial transcranial sonography through the temporal window of the middle cerebral artery, anterior cerebral artery, posterior cerebral artery, and the internal carotid artery with transcranial Doppler sonography days 2, 4, and 10 of life. Cerebral blood velocities (CBFVs) were measured including median velocity flow (MV), peak systolic velocity (PSV), and maximum end-diastolic velocity (EDV). Resistance index and pulsatility index were calculated. VSP was defined as an increase of 50% in the baseline velocity per day and/or a Lindegaard ratio higher than 3. Fifty subjects were enrolled. None of the patients with IVH showed elevation of MV or a Lindegaard ratio > 3. There were no differences between IVH and without IVH groups regarding resistance index and pulsatility index. Conclusion: Preterm infants with IVH do not present a pattern of VSP analyzed by Doppler transcranial ultrasound in this pilot study. What is Known: • In adult population with subarachnoid hemorrhage the most treatable cause of cerebral ischemia is due cerebral vasospasm but is unknown if premature newborn may have vasospasm due the extravasation of blood in the context of intraventricular hemorrhage What is New: •In this pilot study we did not find in premature newborn with intraventricular hemorrhage signs of vasoespam measured by transcranial color doppler ultrasound.

The relationship between mean platelet volume (MPV) and intraventricular hemorrhage in very low birth weight infants.

Intra ventricular hemorrhage (IVH) is a major cause of mortality among very low birth weight infants. This study aimed to investigate the relationship between mean platelet volume (MPV) and IVH in very low birth weight infants. In this cohort study, all premature infants weighing less than 1500 grams who were admitted to the NICU were enrolled from August 2018 to July 2019. Brain ultrasonography was performed on the first and seventh days and one month of age and were compared with Platelet count and MPV. From 183 neonates, 23 cases (12.6%) had IVH. The mean MPV on the first day in the group with IVH was 10.48±0.85 and in the non-IVH group was 9.9±0.74 (P = 0.005). The mean MPV on the seventh day in the IVH and non-IVH group were 10.4±0.92 and 10.03±0.74 (P = 0.04) respectively. On the first and seventh day, for one unit of MPV increase, the chance of IVH increased by 2.68 and 2.1 respectively. (p = 0.001; OR3.643; 95% CI [1.703-7.753]). The mean MPV index is significantly higher in the infants with IVH and therefore it can be used in early detection of IVH in neonates weighing less than 1500 grams.

Hemodynamic evaluation of extremely low birth weight infants during the first 7 days of life

Background and aimWe aimed to investigate the hemodynamic status of extremely low birth weight (ELBW) infants during the transitional period under intensive management. MethodsThis retrospective cohort study analyzed left ventricular ejection fraction (LVEF), left ventricular end-systolic wall stress (ESWS), left ventricular internal dimension in diastole (LVIDd), and mean arterial pressure (MAP) of ELBW infants during their first week of life. Small for gestational age (SGA), histological chorioamnionitis (hCAM), severe intraventricular hemorrhage (IVH), and non-survival to discharge infants were compared to their counterparts. ResultsSixty-two infants (25.7 ± 2.1 weeks, 700.7 ± 165.4 g) were analyzed. MAP gradually increased. Median LVEF was 69.8 % on day 1, decreased to 62.7 % on day 2, then increased throughout the week. ESWS was lowest at birth, rose to 28.2 g/cm2 on day 2, and decreased on day 6. There were no significant changes in LVIDd. SGA infants had higher MAP throughout, higher LVEF on day 2 and 3, but lower LVEF on day 5 to 7. LVIDd was lower in hCAM group. Severe IVH group had a more significant drop in LVEF on day 2, higher ESWS, and a higher incidence of hemodynamic significant patent ductus arteriosus (hsPDA). Non-survival had lower LVIDd. ConclusionsMAP increased gradually. Hemodynamic instability was observed in the first two days, with decreased LVEF and increased ESWS before stabilization. We observed an alteration in hemodynamic adaptation in SGA and hCAM infants. Severe IVH group experienced early hemodynamic instability and a higher incidence of hsPDA.

The role of blood pressure variability indicators combined with cerebral blood flow parameters in predicting intraventricular hemorrhage in very low birth weight preterm infants.

Hemodynamic instability is the main factor responsible for the development of intraventricular hemorrhage (IVH) in premature newborns. Herein, we evaluated the predictive ability of blood pressure variability (BPV) and anterior cerebral artery (ACA) blood flow parameters in IVH in premature infants with gestational age (GA) ≤32 weeks and birth weight (BW) ≤ 1,500 g. Preterm infants with GA ≤32 weeks and BW ≤ 1,500 g admitted to the neonatal intensive care unit (NICU) of the hospital affiliated to Yangzhou University from January 2020 to January 2023 were selected as the research subjects. All preterm infants were admitted within 1 h after birth, and systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) were monitored at 1-h intervals. The difference between maximum and minimum values (max-min), standard deviation (SD), coefficient of variation (CV), and successive variation (SV) were used as BPV indicators. On the 1st, 3rd, and 7th day after birth, transcranial ultrasound examination was performed to screen for the occurrence of IVH. On the 24 ± 1 h after birth, systolic velocity (Vs), diastolic velocity (Vd), and resistance index (RI) of the ACA were measured simultaneously. Preterm infants were divided into the IVH group and non-IVH group based on the results of transcranial ultrasound examination, and the correlation between BPV indicators, ACA blood flow parameters, and development of IVH was analyzed. A total of 92 premature infants were enrolled, including 49 in the IVH group and 43 in the non-IVH group. There was no statistically significant difference in baseline characteristics such as BW, GA, sex, and perinatal medical history between the two groups of preterm infants (P > 0.05). The SBP SD (OR: 1.480, 95%CI: 1.020-2.147) and ACA-RI (OR: 3.027, 95%CI: 2.769-3.591) were independent risk factors for IVH in premature newborns. The sensitivity and specificity of combined detection of SBP SD and ACA-RI in predicting IVH were 61.2% and 79.1%, respectively. High BPV and ACA-RI are related to IVH in premature infants with GA ≤32 w and BW ≤1,500 g. Combined detection of SBP SD and ACA-RI has a certain predictive effect on early identification of IVH.

Neurodevelopmental Outcomes and Brain Volumetric Analysis of Low-Grade Intraventricular Hemorrhage

Purpose: Extremely preterm infants are prone to brain injury and underdevelopment. Intraventricular hemorrhage (IVH) is the most common cause of brain injury and a significant risk factor for neurodevelopmental delay in preterm infants. Severe IVH is known to have a poor outcome; however, the outcomes of low-grade IVH remain controversial. This study aimed to evaluate neurodevelopmental outcomes and brain segmental volumes of preterm infants with low-grade IVH.Methods: This retrospective cohort study included 109 extremely preterm infants who underwent term equivalent age-magnetic resonance imaging and neurodevelopmental evaluation at a corrected age of 18 to 24 months. We compared infants with and without low-grade IVH.Results: Among the 109 extremely preterm infants, 25 had low-grade IVH and 84 had no IVH. There were no significant differences in the neurodevelopmental outcomes between the low-grade and no IVH groups. In multivariate analysis, low-grade IVH was associated with a smaller medullary volume (adjusted odds ratio, 0.575; 95% confidence interval, 0.346 to 0.957; &lt;i&gt;P&lt;/i&gt;=0.034).Conclusion: We found no significant differences in the neurodevelopmental outcomes of extremely preterm infants at a corrected age of 18 to 24 months between those with low-grade IVH and those without IVH. Low-grade IVH was associated with a smaller medullary volume.

Circular RNA hsa_circ_0087893 participates in intraventricular hemorrhage occurrence and progression possibly as a competitive endogenous RNA in preterm infants

To screen for differentially expressed circular RNAs (circRNAs) in the serum of preterm infants with intraventricular hemorrhage (IVH) and explore the competitive endogenous RNA (ceRNA) mechanism of circRNAs in IVH in these infants. Fifty preterm infants (gestational age of 28 to 34 weeks) admitted in our department between January, 2019 and January, 2020 were enrolled in this study, including 25 with a MRI diagnosis of IVH and 25 without IVH. Serum samples were collected from 3 randomly selected infants from each group for profiling differentially expressed circRNAs using circRNA array technique. Gene ontology (GO) and pathway analyses were performed to reveal the function of the identified circRNAs. The circRNA-miRNA-mRNA network was constructed to identify the co-expression network of hsa_circ_ 0087893. A total of 121 differentially expressed circRNAs were identified in the infants with IVH, including 62 up-regulated and 59 down-regulated circRNAs. GO and pathway analyses showed that these circRNAs were involved in multiple biological processes and pathways, including cell proliferation, activation and death, DNA damage and repair, retinol metabolism, sphingolipid metabolism, cell adhesion molecules. Among these circRNAs, hsa_circ_0087893 was found to have significant down-regulation in IVH group and co-express with 41 miRNAs and 15 mRNAs (such as miR-214-3p, miR-761, miR-183-5p, AKR1B1, KRT34, PPP2CB, and HPRT1). The circRNA hsa_circ_0087893 may function as a ceRNA and play an important role in the occurrence and progression of IVH in preterm infants.

The prognosis of refractory hypotension and severe intraventricular hemorrhage in very low birth weight infants.

Background:The increased survival rate among very low birth weight infants has resulted in a higher risk for developing neuro-complications such as intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and adverse neurodevelopmental outcomes.Purpose:We examined refractory hypotension experienced within a week of life in association with severe IVH (grades 3–4) among very low birth weight infants (VLBWIs).Method:Between Jan 2014 and Dec 2017, the clinical data of 191 VLBWIs were retrospectively chart reviewed. Of a total of 191 VLBWIs, 71.2% (136/191) had IVH, and 28.7% (55/191) had severe IVH.Results:The VLBWI with severe IVH group (grade 3–4) presented with a significantly lower gestational age along with higher use of postnatal hydrocortisone for refractory hypotension within a week of life. Resuscitation at delivery, pulmonary hemorrhage, neonatal seizure, and PVL were significantly more frequent in the severe IVH group (P < .05). Higher mortality occurred in the VLBWI with severe IVH group (P < .001). The multivariable logistic regression analysis consistently showed that refractory hypotension within a week of life and neonatal seizures were significantly associated with severe IVH. Those in the severe IVH and refractory hypotension groups had significantly lower composite cognitive, language, motor scores in Bayley Scales of Infant and Toddler Development III scores at corrected 18–24 months.Conclusion:Refractory hypotension within a week of life and seizures were consistently associated with severe IVH and developmental delay at corrected 18–24 months. VLBWI who experienced refractory hypotension within a week of life may indicate a more vulnerable clinical setting with a higher risk for developmental delay.

Changes in Internal Cerebral Vein Pulsation and Intraventricular Hemorrhage in Extremely Preterm Infants.

This study aimed to investigate the relationship between internal cerebral vein (ICV) pulsation and intraventricular hemorrhage (IVH) and to identify the cut-off values that predict IVH. We hypothesized that the severity of ICV flow pulsations was related to IVH severity. In this prospective observational study, ICV flow was measured in 61 extremely preterm infants using ultrasonography at every 12 hours until 96 hours after birth and on days 7, 14, and 28. The ICV pulsation index (ICVPI = minimum/maximum ICV speed) was calculated and compared among the groups determined by Papile's IVH classification. The ICVPI cut-off values for IVH were determined by receiver operating characteristic curve analysis. Compared with those in the no IVH (NIVH) group (n = 51), the ICVPI median values in the severe IVH (SIVH; grades 3 and 4) group (n = 5) were lower at 25 to 96 hours and on day 7, whereas those in the mild IVH (MIVH; grades 1 and 2) group (n = 5) were lower at 37 to 60 hours. All SIVH events were initially detected within 60 hours after birth. The ICVPI cut-off values for SIVH were 0.92 at 13 to 24 hours, 0.42 at 25 to 36 hours, 0.58 at 37 to 48 hours, and 0.55 at 49 to 60 hours. Infants whose ICVPI values were below the cut-off value ≥3 times between 13 and 60 hours had a significantly higher SIVH incidence than those whose ICVPI values were below the cut-off value ≤2 times (57.1 vs. 1.9%, p < 0.001). Our results indicate that SIVH had sustained pronounced internal cerebral vein pulsations and that the ICVPI values may help predict SIVH. Further research on strategies to decrease venous pressure for IVH prevention is needed. · IVH preterm infants had sustained ICV pulsations.. · ICV flow in SIVH pulsated stronger.. · ICVPI fluctuation implies postnatal adaptation.. · We newly defined ICVPI to predict SIVH..

Pharmacological inhibition of TLR4-NF-κB signaling by TAK-242 attenuates hydrocephalus after intraventricular hemorrhage

Compelling evidence has confirmed that inflammatory pathways involving TLR4-regulated cytokines and immune cells are vitallyimportant for the pathogenesis of posthemorrhagic hydrocephalus (PHH), hinting that pharmacological prevention of PHH is feasible. TAK-242, as a toll-like receptor 4 (TLR4) inhibitor, downregulates TLR4-induced inflammatory responses and becomes a potent and noveltherapeuticdrugcandidatefor PHH. In the present study, we investigate whether TAK-242 protects against hydrocephalus and improves the prognosis of intraventricular hemorrhage (IVH). We also explore the possible role of TAK-242 for the regulation of TLR4-NF-κB signaling pathway. A model of PHH was conducted in 6-week-old Male Sprague-Dawley (SD) rats. The rats were divided into four main groups, including the sham, IVH + vehicle, IVH + TAK-242 and IVH groups. Magnetic resonance imaging (MRI) was applied to measure the lateral ventricle volume. Western blot (WB) and immunofluorescence (IF) were applied to detect the expression of TLR4, NF-κB, fibronectin and laminin. A combined scoring system and Morris water maze were employed to evaluate neurological functions after IVH. We found that IVH induced heightened activation of TLR4-NF-κB signaling pathway. We observed the increased lateral ventricular volume, elevation of NF-κB in choroidplexus, as well as fibronectin and laminin in the subarachnoid space (SAS) and ventricular wall after IVH. Obviously, TAK-242 treatment effectively inhibited the up-regulation of NF-κB, fibronectin, laminin and significantly alleviated ventriculomegaly after IVH. Importantly, TAK-242 improved neurocognitive deficits after PHH. In conclusion, TAK-242 attenuated IVH-induced hydrocephalus and improved the prognosis of PHH. The underlying mechanism involved the TAK-242-mediated downregulation of TLR4-NF-κB signaling pathway.

The Effect of Intraventricular Hemorrhage on Brain Development in Premature Infants: A Synthetic MRI Study.

Objectives: Synthetic MRI can obtain multiple parameters in one scan, including T1 and T2 relaxation time, proton density (PD), brain volume, etc. This study aimed to investigate the parameter values T1 and T2 relaxation time, PD, and volume characteristics of intraventricular hemorrhage (IVH) newborn brain, and the ability of synthetic MRI parameters T1 and T2 relaxation time and PD to diagnose IVH.Materials and methods: The study included 50 premature babies scanned with conventional and synthetic MRI. Premature infants were allocated to the case group (n = 15) and NON IVH (n = 35). The T1, T2, PD values, and brain volume were obtained by synthetic MRI. Then we assessed the impact of IVH on these parameters.Results: In the posterior limbs of the internal capsule (PLIC), genu of the corpus callosum (GCC), central white matter (CWM), frontal white matter (FWM), and cerebellum (each p < 0.05), the T1 and T2 relaxation times of the IVH group were significantly prolonged. There were significant differences also in PD. The brain volume in many parts were also significantly reduced, which was best illustrated in gray matter (GM), cerebrospinal fluid and intracranial volume, and brain parenchymal fraction (BPF) (each p < 0.001, t = −5.232 to 4.596). The differential diagnosis ability of these quantitative values was found to be excellent in PLIC, CWM, and cerebellum (AUC 0.700–0.837, p < 0.05).Conclusion: The quantitative parameters of synthetic MRI show well the brain tissue characteristic values and brain volume changes of IVH premature infants. T1 and T2 relaxation times and PD contribute to the diagnosis and evaluation of IVH.

Efficiency of a deep learning-based artificial intelligence diagnostic system in spontaneous intracerebral hemorrhage volume measurement

BackgroundAccurate measurement of hemorrhage volume is critical for both the prediction of prognosis and the selection of appropriate clinical treatment after spontaneous intracerebral hemorrhage (ICH). This study aimed to evaluate the performance and accuracy of a deep learning-based automated segmentation algorithm in segmenting spontaneous intracerebral hemorrhage (ICH) volume either with or without intraventricular hemorrhage (IVH) extension. We compared this automated pipeline with two manual segmentation techniques.MethodsWe retrospectively reviewed 105 patients with acute spontaneous ICH. Depending on the presence of IVH extension, patients were divided into two groups: ICH without (n = 56) and with IVH (n = 49). ICH volume of the two groups were segmented and measured using a deep learning-based artificial intelligence (AI) diagnostic system and computed tomography-based planimetry (CTP), and the ABC/2 score were used to measure hemorrhage volume in the ICH without IVH group. Correlations and agreement analyses were used to analyze the differences in volume and length of processing time among the three segmentation approaches.ResultsIn the ICH without IVH group, the ICH volumes measured using AI and the ABC/2 score were comparable to CTP segmentation. Strong correlations were observed among the three segmentation methods (r = 0.994, 0.976, 0.974; P < 0.001; concordance correlation coefficient [CCC] = 0.993, 0.968, 0.967). But the absolute error of the ICH volume measured by the ABC/2 score was greater than that of the algorithm (P < 0.05). In the ICH with IVH group, there is no significant differences were found between algorithm and CTP(P = 0.614). The correlation and agreement between CTP and AI were strong (r = 0.996, P < 0.001; CCC = 0.996). The AI segmentation took a significantly shorter amount of time than CTP (P < 0.001), but was slightly longer than ABC/2 score technique (P = 0.002).ConclusionsThe deep learning-based AI diagnostic system accurately quantified volumes of acute spontaneous ICH with high fidelity and greater efficiency compared to the CTP measurement and more accurately than the ABC/2 scores. We believe this is a promising tool to help physicians achieve precise ICH quantification in practice.

S100B protein, cerebral ultrasound and magnetic resonance imaging patterns in brain injured preterm infants.

The early detection of preterm infants (PI) at risk for intraventricular hemorrhage (IVH) and neurological sequelae still constitutes an unsolved issue. We aimed at validating the role of S100B protein in the early diagnosis and prognosis of IVH in PI by means of cerebral ultrasound (CUS) and magnetic resonance imaging (MRI) today considered standard of care procedures. We conducted an observational case-control study in 216 PI of whom 36 with IVH and 180 controls. Standard clinical, laboratory, radiological monitoring procedures and S100B urine measurement were performed at four time-points (first void, 24, 48, 96h) after birth. Cerebral MRI was performed at 40-42weeks of corrected gestational age. Elevated (p<0.001, for all) S100B levels were observed in the IVH group at all monitoring time-point particularly at first void when standard monitoring procedures were still silent or unavailable. S100B measured at first void correlated (p<0.001) with the grade of hemorrhage by means of CUS and with the site and extension of neurological lesion (p<0.001, for all) as assessed by MRI. The present results showing a correlation among S100B and CUS and MRI offer additional support to the inclusion of the protein in clinical daily management of cases at risk for IVH and adverse neurological outcome. The findings open the way to further investigations in PI aimed at validating new neurobiomarkers by means of S100B.

Effects of intraventricular hemorrhage on white matter microstructural changes at term and early developmental outcomes in infants born very preterm.

Very preterm (VPT) infants are at high risk for motor and behavioral deficits. We investigated microstructural differences using diffusion tensor imaging (DTI) among VPT infants with different grades of intraventricular hemorrhage (IVH), their association with early motor function and temperament ratings, and the potential moderating effect of IVH severity on the above structure-function relations. Fifty-seven VPT (≤32weeks gestational age) infants with IVH (Low Grade (Papile grading I/II): 42; High Grade (III/IV): 15) were studied. DTI was acquired between 39 and 44weeks postmenstrual age and was analyzed using the tract-based spatial statistics approach. Early motor function and temperament were assessed at 3-month corrected age based on the Hammersmith Infant Neurological Examination (HINE) and Infant Behavioral Questionnaire - Revised, Short Version (IBQ-R-S), respectively. Significantly lower fractional anisotropy and higher mean, axial, and/or radial diffusivity were found in VPT infants with High Grade IVH compared to Low Grade IVH (p< 0.05). Significant associations were found between DTI metrics and motor function in both IVH groups and between DTI and Fear temperament ratings in the High Grade IVH Group (all p< 0.05). IVH severity had a significant moderating effect on the relation between DTI and motor and Fear ratings (p< 0.05). DTI is a sensitive neuroimaging biomarker providing a refined understanding of the impact and location of differing severities of IVH on the developing white matter of VPT infants. Early motor and behavioral outcomes are associated with microstructural changes that are influenced by severity of IVH.

Uncomplicated intraventricular hemorrhage is not associated with lower estimated cerebral volume at term age.

Cerebral lesions detected using cerebral ultrasound (cUS) in very preterm infants are associated with increased risk for neurodevelopmental problems. However, uncomplicated intraventricular hemorrhage (IVH) has no consistent association with poor outcome. In this study we evaluate the effect of uncomplicated IVH on estimated brain volume at term-equivalent age (TEA), using a model based on measurements made from cUS. We studied 2 groups of preterm infants (<32 weeks' gestational age (GA)) up to and at TEA: (1) infants with uncomplicated grades 2 or 3 IVH, (2) infants with consistently normal scans. Estimated cerebral volumes at TEA were calculated using a previously described model based on linear measurements and compared between the 2 groups using independent groups t-test or the Mann-Whitney test; p-value <0.05 was considered significant. We assessed 95 preterm infants (18 with uncomplicated IVH and 71 with normal scans). GA and birth weight were lower in infants with uncomplicated IVH (26.8/28.7weeks, p<0.001, 944/1082g, p<0.05, respectively); occipital-frontal circumference at TEA was smaller in the IVH infants (34.2 vs 35.3cm, p<0.05). However, no significant differences at TEA were found for estimated cranial volume (383/411cc3), estimated cerebral volume (337/341cc3), Levene ventricular index (13.5/12.2mm) or thalamo-occipital distance (21.5/20.3mm). Statistical adjustment for the lower GA in the IVH group confirmed the absence of a significant difference in the findings. In summary, we found that estimated cerebral volume at TEA, based on measurements made at the bedside using cranial US, is not different between very preterm infants with consistently normal scans and those with uncomplicated grades 2 and 3 IVH.

Pharmacological Inhibition of TLR4-NF-κB Signaling by TAK-242 Attenuates Hydrocephalus after Intraventricular Hemorrhage

Compelling evidence has confirmed that inflammatory pathways involving TLR4-regulated cytokines and immune cells are vitally important for the pathogenesis of posthemorrhagic hydrocephalus (PHH), hinting that pharmacological prevention of PHH is feasible. TAK-242, as a toll-like 4 receptor (TLR4) inhibitor, downregulates TLR4-induced inflammatory responses and becomes a potent and novel therapeutic drug candidate for PHH. In the present study, we investigate whether TAK-242 protects against hydrocephalus and improves the prognosis of intraventricular hemorrhage (IVH). We also explore the possible role of TAK-242 for the regulation of TLR4-NF-κB signaling pathway. A model of PHH was conducted in 6-week-old Male Sprague-Dawley rats. The rats were divided into four main groups, including the sham, IVH+ vehicle, IVH+ TAK-242 and IVH groups. Magnetic resonance imaging was applied to measure the lateral ventricle volume. Western blot (WB) and immunofluorescence (IF) were applied to detect the expression of TLR4, NF-κB, fibronectin and laminin. A combined scoring system and Morris water maze were employed to evaluate neurological functions after IVH. We found that IVH induced heightened activation of TLR4-NF-κB signaling pathway. We observed the increased lateral ventricular volume, elevation of NF-κB in choroid plexus, as well as fibronectin and laminin in the subarachnoid space (SAS) and ventricular wall after IVH. Obviously, TAK-242 treatment effectively inhibited the up-regulation of NF-κB, fibronectin, laminin and significantly alleviated ventriculomegaly after IVH. Importantly, TAK-242 improved neurocognitive deficits after PHH. In conclusion, TAK-242 attenuated IVH-induced hydrocephalus and improved the prognosis of PHH. The underlying mechanism involved the TAK-242-mediated downregulation of TLR4-NF-κB signaling pathway.

Effect of Transfusion on the Extension of IVH in Preterm Neonates

Background: Today, preterm birth is well known as the major risk factor for intraventricular hemorrhage (IVH). In the first week of life, some preterm infants may have grade 1 IVH extending to severe (grade 3 or 4) IVH by transfusion one or more units. Several previous studies have found that blood and blood product transfusions lead to adverse clinical outcomes in neonates. Therefore, this study aimed to explore the relationship between Red blood cell (RBC) transfusion and extension of IVH in preterm infants.Methods: For the purposes of the study, an observational retrospective case-control design was utilized. Moreover, all the neonates with grade 1 IVH in our referral hospital were identified in the past 5 years. Afterward, the subjects with extended IVH were compared with those who had resolved IVH.Results: In total, 1050, 36, and 24 neonates were diagnosed with grade 1, grade 3, and grade 4 IVH, respectively. The mean values of the birth weight of extended IVH and resolved IVH groups were 1285±615 g and 1361±348 g, respectively (P=0.05). Moreover, extended IVH and resolved IVH groups were 29±3 weeks and 30±2 weeks premature, respectively (P=0.36). The low 5-minute Apgar scores of the extended IVH and resolved IVH groups were 5±2 and 7±2, respectively (P=0.000). In addition, the low cord pH of the extended IVH and resolved IVH groups were 7.29±0.1 and 7.37±0.1, respectively (P=0.005). Administration of packed RBC transfusion before and on the day of the diagnosis of grade 1 IVH had the most significant relationship with the extension of IVH (IR, 10.602; 95% CI, 2.81-39.92). The obtained results confirmed that criteria to order the transfusions were similar in both groups, based on which they did not have any proportion of the transfusions of compliance with the guidelines.Conclusion: Based on the results, there was a great association between restrictive RBC transfusion and extension of a low-grade IVH into a higher grade (3 or 4) IVH. However, the statistical explanation is unclear and more studies are needed to discover the causality of this relationship.

Risk factors for intraventricular hemorrhage in premature infants in the central region of Saudi Arabia.

BackgroundIntraventricular hemorrhage (IVH) is a serious complication of premature (<32 weeks) deliveries, especially in very-low-birth-weight (VLBW; <1500 g) neonates. Infants developing severe IVH are more prone to long-term developmental disabilities. Although 62%–79% of women in Saudi Arabia receive antenatal steroids, IVH incidence remains high. We analyzed the risk factors for IVH in preterm VLBW neonates in the central region of Saudi Arabia.MethodsWe included premature infants with IVH (n = 108) and gestational age- and birth weight-matched control group infants (n = 108) admitted to our neonatal intensive care unit. Cases were divided into mild (grades I and II; n = 56) and severe (grades III and IV; n = 52) IVH groups. Association of IVH with risk factors in the first week of life was investigated.ResultsThe following risk factors were associated with severe IVH: lack of antenatal steroid administration (P < .001), pulmonary hemorrhage (P = .023), inotrope use (P = .032), neonatal hydrocortisone administration (P = .001), and patent ductus arteriosus (PDA) (P = .005). Multivariable logistic regression analysis revealed the following to be significant: lack of antenatal dexamethasone (adjusted odds ratio [aOR]: 0.219, 95% confidence interval [95% CI] 0.087–0.546), neonatal hydrocortisone administration (aOR: 3.519, 95% CI 1.204–10.281), and PDA (aOR: 2.718, 95% CI 1.024–7.210). Low hematocrit in the first 3 days of life was significantly associated with severe IVH (all P < .01).ConclusionsFailure to receive antenatal dexamethasone, PDA, hydrocortisone administration for neonatal hypotension, and low hematocrit in the first 3 days of life was associated with severe IVH in VLBW neonates. Clinicians and healthcare policy makers should consider these factors during decision-making.

Correlation of early fluctuation management on intraventricular hemorrhage in very/extremely low birth weight infant

Objective To investigate the correlation of early incubator temperature fluctuation on intraventricular hemorrhage (IVH) in very/extremely-low birth weight infants (E/VLBW). Methods From July 2015 to September 2016, 270 patients of hospitalized E/VLBW were included in this study. Temperature changes including incubator temperature and abdominal temperature within 72 hours after admission and routine clinical data were collected,the E/VLBW were divided into IVH group and non-IVH group, as well as the occurrence and grading of IVH. Chi-square test, t test and nonparametric test and logistic regression analysis were used to explore the effect of early incubator temperature fluctuations in E/VLBW on IVH. Results Of the 270 V/ELBW studied, the incidence of IVH was 24.4% (66/270) , severe IVH(grade Ⅲ and Ⅳ) was 5.2% (14/270) . Univariate analysis showed that in addition to common IVH risk factors such as gestational age, body weight, 1/5 min Apgar score, sex, delivery, hyperglycemia, prenatal steroid and mechanical ventilation, fluctuations of body temperature and incubator temperature were relevant for IVH in E/VLBW (P<0.05) . Logistic regression analysis of the above relevant risk factors showed fluctuations of temperature (OR=1.10) was also an independent risk factor for IVH in E/VLBW(P<0.05) , in addition to sex(OR=0.42) , 1 min Apgar score (OR=0.71) , and hyperglycemia (OR=3.67) . Conclusion Fluctuation of incubator temperature is an independent risk factor for IVH in V/ELBWI. During centralized nursing and nursing operations, the operating time should be shortened as much as possible to reduce the number of fluctuations of incubators and body temperature to reduce the incidence of IVH and improve the quality of life. Key words: Temperature; Nursing care; Very/ extremely-low birth weight infants; Intracranial hemorrhage

Changes in hemodynamics, cerebral oxygenation and cerebrovascular reactivity during the early transitional circulation in preterm infants.

Changes in systemic and cerebral hemodynamics in preterm infants during early transitional circulation are complex and may differ between infants with or without intraventricular hemorrhage (IVH). In total, 43 infants born at median (range) 25 + 5 (23 + 3-31) had continuous near-infrared spectroscopy (NIRS) monitoring of tissue oxygenation index (TOI) and cerebrovascular reactivity within the first 48 h of life. Measurements of left and right cardiac outputs (LVO, RVO) and patent ductus arteriosus (PDA) were collected at 6, 12, 24, and 48 h of life. LVO increased within the first 48 h in the IVH (P = 0.007) and no-IVH (P < 0.001) groups. The pattern of change in LVO and RVO was not different between these two groups. TOI was lower in the IVH (P < 0.001) group. A positive correlation between TOI and LVO (P = 0.003) and a negative correlation between the tissue oxygen reactivity index (TOx) and LVO (P = 0.04) were observed at 24 h of life in the IVH group. PDA diameter was not different between IVH groups at any time interval. Cerebral oxygenation was lower and cerebrovascular reactivity was passive to systemic blood flow at 24 h in infants who developed an IVH.

Incidence and risk factors of severe intraventricular hemorrhage in very low and extremely low birth weight infants: a multi-center study

Objective: To investigate the incidence and risk factors of severe intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI). Methods: The data were from "reduction of infection in Chinese neonatal intensive care units using the evidence-based practice for improving quality"study, which prospectively enrolled infants with gestational age less than 34 weeks, and were admitted within the first seven days of life in 25 tertiary neonatal intensive care units from May 2015 to April 2018. Clinical data of VLBWI and ELBWI, who had neuroimage examination during the hospitalization, were retrospectively extracted from the standard database and were secondarily-analyzed. Patients with congenital malformations were excluded. A total of 8 835 VLBWI and ELBWI were enrolled with 52.6% (4 643 cases) male, who were divided into severe IVH group and without IVH or mild IVH group. Descriptive statistics were used to analyze the incidence of severe IVH. Comparison between two groups and risk factors were analyzed with univariate and multivariate Logistic regression analysis. Results: The incidence of severe IVH in the 8 835 infants was 7.4% (650/8 835). And the incidences of severe IVH in ELBWI and preterm infants with gestational age ≤28 weeks were 13.5% (160/1 185) and 13.1% (368/2 800), respectively. The incidences of severe IVH in preterm infants with birth weight<750 g, 750-999 g, 1 000-1 249 g, 1 250-1 499 g were 21.1% (31/147), 12.4% (129/1 038), 8.3% (246/2 966) and 5.2% (244/4 684), respectively; and were 25.2% (55/218), 12.1% (313/2 582), 5.2% (243/4 649) and 2.8% (39/1 386) in the preterm infants with gestational age<26 weeks, 26-28(+6) weeks, 29-31(+6) weeks, 32-33(+6) weeks, respectively. Logistic regression analysis revealed that gestation age (OR=0.752, 95%CI: 0.687-0.823, P=0.000) and cesarean delivery (OR=0.733, 95%CI: 0.592-0.907, P=0.004) decreased the risks of severe IVH; while Apgar score ≤3 at 5 minutes (OR=1.897, 95%CI: 1.194-3.013, P=0.007), use of invasive mechanical ventilation within the first week (OR=1.499, 95%CI: 1.207-1.862, P=0.000), use of inotropic medications within the first week (OR=2.093, 95%CI: 1.724-2.541, P=0.000) increased the risks of severe IVH. Conclusions: The incidence of severe IVH is still significantly high among VLBWI and ELBWI. Low gestation age, non-cesarean delivery, Apgar score ≤3 at 5 minutes, use of invasive mechanical ventilation and inotropic medications within the first week of life will increase the risk of severe IVH.