Intraventricular Hemorrhage In Preterm Infants Research Articles

The Diastolic Closing Margin Is Associated with Intraventricular Hemorrhage in Premature Infants.

Premature infants are at an increased risk of intraventricular hemorrhage (IVH). The roles of hypotension and hyperemia are still debated. Critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow (CBF) ceases. When diastolic ABP is equal to CrCP, CBF occurs only during systole. The difference between diastolic ABP and CrCP is the diastolic closing margin (DCM). We hypothesized that a low DCM was associated with IVH. One hundred eighty-six premature infants, with a gestational age (GA) range of 23-33 weeks, were monitored with umbilical artery catheters and transcranial Doppler insonation of middle cerebral artery flow velocity for 1-h sessions over the first week of life. CrCP was calculated linearly and using an impedance model. A multivariate generalized linear regression model was used to determine associations with severe IVH (grades 3-4). An elevated DCM by either method was associated with IVH (p < 0.0001 for the linear method; p < 0.001 for the impedance model). Lower 5-min Apgar scores, elevated mean CBF velocity, and lower mean ABP were also associated with IVH (p < 0.0001). Elevated DCM, not low DCM, was associated with severe IVH in this cohort.

Treatment of posthemorrhagic ventricular dilation in preterm infants: a systematic review and meta-analysis of outcomes and complications.

OBJECT The optimal clinical management of intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilation (PHVD)/posthemorrhagic hydrocephalus (PHH) in premature infants remains unclear. A common approach involves temporary treatment of hydrocephalus in these patients with a ventriculosubgaleal shunt (VSGS), ventricular access device (VAD), or external ventricular drain (EVD) until it becomes evident that the patient needs and can tolerate permanent CSF diversion (i.e., ventriculoperitoneal shunt). The present systematic review and meta-analysis aimed to provide a robust and comprehensive summary of the published literature regarding the clinical outcomes and complications of these 3 techniques as temporizing measures in the management of prematurity-related PHVD/PHH. METHODS The authors searched MEDLINE, EMBASE, CINAHL, Google Scholar, and the Cochrane Library for studies published through December 2013 on the use of VSGSs, VADs, and/or EVDs as temporizing devices for the treatment of hydrocephalus following IVH in the premature neonate. Data pertaining to patient demographic data, study methods, interventions, and outcomes were extracted from eligible articles. For each of the 3 types of temporizing device, the authors performed meta-analyses examining 6 outcomes of interest, which were rates of 1) obstruction; 2) infection; 3) arrest of hydrocephalus (i.e., permanent shunt independence); 4) mortality; 5) good neurodevelopmental outcome; and 6) revision. RESULTS Thirty-nine studies, representing 1502 patients, met eligibility criteria. All of the included articles were observational studies; 36 were retrospective and 3 were prospective designs. Nine studies (n = 295) examined VSGSs, 24 (n = 962) VADs, and 9 (n = 245) EVDs. Pooled rates of outcome for VSGS, VAD, and EVD, respectively, were 9.6%, 7.3%, and 6.8% for obstruction; 9.2%, 9.5%, and 6.7% for infection; 12.2%, 10.8%, and 47.3% for revision; 13.9%, 17.5%, and 31.8% for arrest of hydrocephalus; 12.1%, 15.3%, and 19.1% for death; and 58.7%, 50.1%, and 56.1% for good neurodevelopmental outcome. CONCLUSIONS This study provides robust estimates of outcomes for the most common temporizing treatments for IVH in premature infants. With few exceptions, the range of outcomes was similar for VSGS, VAD, and EVD.

Maternal Morbidities and Occurrence of Intraventricular Hemorrhage in Preterm Infants.

Intraventricular hemorrhage (IVH) is one of the most serious neurological morbidities in preterm infants. Several prenatal, intrapartum, and neonatal risk factors have been detected in different studies. However, maternal conditions that may render the neonates to IVH have been the subject of very few studies. Preterm infants with and without IVH were included in the study, and maternal obstetrics and general health clinical files were reviewed for any kind of morbidity. Data were then analyzed with statistical software to assess the association between maternal conditions and IVH. A total of 115 neonates with IVH and 120 infants without IVH were recruited. Among all maternal conditions, prolonged rupture of membrane (p = 0.00), laparoscopic surgery for infertility (p = 0.001), and in vitro fertilization (IVF) (p = 0.00) increased the risk of IVH in neonates significantly. IVF remained strongly associated with IVH even after controlling for confounding variables (odds ratio: 9.75; confidence interval: 2.66-35.75; p = 0.001). Based on our findings, prolonged rupture of membrane and IVF were maternal conditions that increased the risk of IVH. Laparoscopic surgery for infertility was also associated with an increased risk of IVH.

Factores asociados a Hemorragia Intraventricular en Neonatos Prematuros en el Hospital Regional Docente de Trujillo. Diciembre 2011 a Diciembre 2013

Objetivo: Determinar los factores asociados a hemorragia intraventricular en neonatos prematuros en el Hospital Regional Docente de Trujillo en los periodos Diciembre 2011 a Diciembre 2013.MaterialyMetodos:Se llevo acabo un estudio analitico,retrospectivo de casos y controles.La poblacion estuvo constituida por 108 pacientes:54 neonatos prematuros con Hemorragia intraventricular y 54 neonatos prematuros sin Hemorragia intraventricular.Resultados:El peso al nacer resulto ser significativo(x2:6.438;valorp:0.011)obteniendo mayor frecuencia de peso menor o igual a 1500g.El sexo del recien nacido resulto ser una variable significativa(x2:6.366;valorp:0.012)siendo en su mayoria el sexo masculino.La edad gestacional resulto ser una variable significativa(x2:10.394;valorp:0.001)siendo mas frecuente la edad menor o igual a 32 semanas. La via de nacimiento no fue un factor significativo (x2: 0.150, valor p: 0.699),sin embargo la cesarea fue mas frecuente(OR:0.861).La valoracion de Apgar al minuto y a los 5 minutos no fue una variable significativa. El uso de soluciones hiperosmolares no resulto sersignificativa(x2:0.228,valorp:0.633,OR:0.795).El uso de ventilacion mecanica no fue una variable significativa(x2:1.662,valorp:0.197,OR:1.75). El uso de reanimacion cardiopulmonar no fue una variable significativa(x2:0.055,valorp:0.814,OR:0.895). El uso de surfactante pulmonar no fue una variable significativa(x2:0.892,valorp:0.322,OR:1.643).Conclusion:Los factores asociados a hemorragia intraventricular son el peso al nacer menor o igual a 1500g,edad gestacional menor a 32semanas y el sexo masculino,sin embargo la via de nacimiento,la valoracion deApgar,el uso de soluciones hiperosmolares, el uso ventilacion mecanica,el requerimiento de reanimacion cardio pulmonar y uso de surfactante pulmonar no fueron factores de riesgo.El grado de Hemorragia intraventricular en neonatos prematuros fue el GradoI segun la clasificacion de Papile.(HorizMed2015;15(2):19-26)

Minireview: the impact of antenatal therapeutic synthetic glucocorticoids on the developing fetal brain.

The life-threatening, emotional, and economic burdens of premature birth have been greatly alleviated by antenatal glucocorticoid (GC) treatment. Antenatal GCs accelerate tissue development reducing respiratory distress syndrome and intraventricular hemorrhage in premature infants. However, they can also alter developmental processes in the brain and trigger adverse behavioral and metabolic outcomes later in life. This review summarizes animal model and clinical studies that examined the impact of antenatal GCs on the developing brain. In addition, we describe studies that assess glucocorticoid receptor (GR) action in neural stem/progenitor cells (NSPCs) in vivo and in vitro. We highlight recent work from our group on two GR pathways that impact NSPC proliferation, ie, a nongenomic GR pathway that regulates gap junction intercellular communication between coupled NSPCs through site-specific phosphorylation of connexin 43 and a genomic pathway driven by differential promoter recruitment of a specific GR phosphoisoform.

O-210 Obstetrical Complications Associated With Preterm Delivery And Intraventricular Haemorrhage In Preterm Infants: Results From The French National Cohort Epipage 2

Backgrouds and aim Despite the improvement in neonatal care, intraventricular haemorrhage (IVH) remains an important cause of neurodevelopmental anomalies in preterm infants (PI). This event is usually associated with gestational age (GA). Others factors like maternal complications associated with preterm delivery could be implicated. We studied the association between these maternal complications and IVH in a large cohort of PI. Methods The data were extracted from the national Epipage 2 study, which included PI born before 32 weeks gestation during the year 2011 (n = 3492). Neonatal and Obstetrical data were collected from the medical records including the postnatal cerebral ultrasound results. We used a polytomic logistic regression to compare the risk of the different grades of IVH according to the usual obstetrical complications associated with preterm birth. Results The incidence of grade 1 IVH was 16.7% [95% CI: 15.2–17.7], grade 2 was 10.5% [95% CI: 9.6–11.6], grade 3 was 5.6% [95% CI: 4.8–6.3] and grade 4: 3.7% [95% CI: 3.1–4.3%]. Infants born when preterm labour with inflammatory syndrome was present had significantly more grade 3 and IV IVH than those exposed to maternal vascular disease (respectively 12.6% and 7.3% vs 1.8% and 3.4%). After adjustment for GA and others confounding factors, grade 4 IVH was strongly associated with preterm labour with inflammation (OR: 1.56 [95% CI: 1.3–18.5]) and placental abruption (OR: 2.3 [95% CI: 1.7–38.0]). Grade 3 IVH was only associated with placental abruption (OR: 4.6 [95% CI: 1.3–16.8]). Discussion This study demonstrates that IVH is associated with other factors independent of GA, as well as certain maternal complications. These results are useful for the management of preterm birth and help better understand the mechanisms of IVH.

Genetic variants of the vitamin K dependent coagulation system and intraventricular hemorrhage in preterm infants.

BackgroundPathogenesis of intraventricular hemorrhage (IVH) in premature infants is multifactorial. Little is known about the impact of genetic variants in the vitamin K-dependent coagulation system on the development of IVH.MethodsPolymorphisms in the genes encoding vitamin K epoxide reductase complex 1 (VKORC1 -1639G>A) and coagulation factor 7 (F7 -323Ins10) were examined prospectively in 90 preterm infants <32 weeks gestational age with respect to coagulation profile and IVH risk.ResultsF7-323Ins10 was associated with lower factor VII levels, but not with individual IVH risk. In VKORC1-wildtype infants, logistic regression analysis revealed a higher IVH risk compared to carriers of the -1639A allele. Levels of the vitamin K-dependent coagulation parameters assessed in the first hour after birth did not differ between VKORC1-wildtype infants and those carrying -1639A alleles.ConclusionsOur data support the assumption that genetic variants in the vitamin K-dependent coagulation system influence the coagulation profile and the IVH risk in preterm infants. Further studies focussing on short-term changes in vitamin K-kinetics and the coagulation profile during the first days of life are required to further understand a possible link between development of IVH and genetic variants affecting the vitamin K-metabolism.

Prenatal betamethasone does not affect glutamatergic or GABAergic neurogenesis in preterm newborns

Prenatal glucocorticoids (GCs) are routinely used for pregnant women in preterm labor to prevent respiratory distress syndrome and intraventricular hemorrhage in premature infants. However, the effect of antenatal GCs on neurogenesis in preterm neonates remains elusive. Herein, we hypothesized that prenatal GCs might suppress both glutamatergic and GABAergic neurogenesis in preterm rabbits and that this treatment would induce distinct changes in the expression of transcription factors regulating these developmental events. To test our hypotheses, we treated pregnant rabbits with betamethasone at E27 and E28, delivered the pups at E29 (term=32d), and assessed neurogenesis at birth and postnatal day 3. We quantified radial glia (Sox2+) and intermediate progenitor cells (Tbr2+) in the dorsal cortical subventricular zone to assess glutamatergic neuronal progenitors, and counted Nkx2.1+ and Dlx2+ cells in the ganglionic eminence to evaluate GABAergic neurogenesis. In addition, we assayed transcription factors regulating neurogenesis. We found that prenatal GCs did not affect the densities of radial glia and intermediate progenitors of glutamatergic or GABAergic neurons. The number of GABA+ interneurons in the ganglionic eminence was similar between the prenatal GC-treated pups compared to untreated controls. Moreover, the mRNA expression of transcription factors, including Pax6, Ngn1/2, Emx1/2, Insm1, Dlx1, Nkx2.1, and Gsh2, were comparable between the two groups. However, there was a transient elevation in Mash1 protein in betamethasone-treated pups relative to controls at birth. These data suggest that prenatal GC treatment does not significantly impact the balance of glutamatergic and GABAergic neurogenesis in premature infants.

Neuro protection for infants

Infants receive a variety of brain injuries—intraventricular hemorrhage in preterm infants, hypoxic ischemic encephalopathy in term infants, and often poorly defined events resulting in cerebral palsy and other neurodevelopmental abnormalities. Recently, specific neuroprotective therapies have been tested to improve, including antenatal magnesium treatment for preterm deliveries and therapeutic hypothermia for hypoxic ischemic encephalopathy. Numerous other neuroprotective treatments, including stem cell treatments and erythropoietin treatments, are being tested in animal models and erythropoietin treatments. In this issue of The Journal, Benders et al report that the treatment of term infants with perinatal arterial ischemic strokes with erythropoietin is safe and feasible. This pilot study should result in formal therapeutic trials. Such interventions are gaining traction as a number of neonatologists are teaming up with pediatric neurologists to develop neurologic neonatal intensive care units to better diagnose and develop treatments for infants at high-risk of brain injury. The use of newer imaging and monitoring tools makes these efforts very likely to succeed. Article page 481▶ Feasibility and Safety of Erythropoietin for Neuroprotection after Perinatal Arterial Ischemic StrokeThe Journal of PediatricsVol. 164Issue 3PreviewTo perform a feasibility and safety study with recombinant human erythropoietin (rhEPO) in neonates with perinatal arterial ischemic stroke. Full-Text PDF

Dwuletnia ocena rozwoju noworodków urodzonych przedwcześnie i hospitalizowanych w ośrodku III stopnia referencji z rozpoznanym krwawieniem około- i dokomorowym II–IV stopnia

IntroductionPeriventricular and intraventricular hemorrhage (IVH) in preterm infants may influence their future development. Although the latest foreign publications indicate changing prognosis at different grades of hemorrhage, Polish literature on this topic is scarce. AimTo present relationship between severity of II–IV grade IVH in preterm infants hospitalized in the 3rd level unit and diagnosed with USG, and neurological outcomes at 2 years corrected age. Material and methodsNinety eight infants who had been admitted to the NICU at the Institute of Mother and Child in Warsaw and diagnosed with II–IV grade IVH were observed. Motor, language, cognitive, visual and hearing developments were assessed at 2 years corrected age. ResultsIntensity of neurological impairments increased with grade of hemorrhage and presence of accompanying cystic periventricular leukomalacia (PVL). In children with III grade IVH without PVL, cerebral palsy did not occur. Cerebral palsy, including tetraplegia, was diagnosed mostly in children with IV grade IVH. ConclusionsShort-term evaluation of preterm infants indicates the possibility of occurrence of cerebral palsy in children with II grade IVH. Neurodevelopment of children with III grade IVH is only slightly worse, as long as it is not accompanied by PVL. Prognosis for infants with IV grade IVH is poor in most of the cases and these children should be handled differently from infants with III grade IVH. Brain MRI in selected cases may improve prediction of neurological impairments in this population.

Diagnostic and evolutionary aspects of intraventricular hemorrhage in preterm infants

Objectives. The aim of this study was to asses the risk factors, the grades of severity, and the complications associated with intraventricular hemorrhage. Methods. The retrospective study, conducted over a period of five years in the Neonatology Clinic Timisoara, included 514 preterm infants with specific sonographic signs of intraventricular hemorrhage (IV). Results. The incidence varied indirectly proportional to gestational age, being higher among preterm VLBW and ELBW. The main incriminated risk factors were: acidosis, respiratory distress syndrome, hypoxia and hypercarbia. The distribution of cases based on the degree of severity was as follows: grade I, 204 patients (39.68%), grade II, 142 patients (27.62%), grade III, 91 cases (17.70%) and grade IV, 77 cases (15%). Most cases were asymptomatic, being diagnosed based on routine ultrasound. 36% had saltatory evolution, with progressive deterioration of neurologic status, altered muscle tone and respiratory distress. 21% had catastrophic evolution with bulging fontanelle, projectile vomiting, seizures, decerebrate posturing, and apneic spells. Upon follow-up at 6 months, the outcome of the sonographic signs depended on the severity of the bleed, 28.9% cases presented complete resorption, 35% germinal matrix cyst and 25.87% ventriculomegaly. Conclusions. Transfontanellar ultrasound was the diagnostic method of choice. Most intraventricular bleedings were diagnosed among VLBW and ELBW infants, and were severe forms of disease. Mild and medium forms of disease had good outcome, with partial/ complete resolution of the ultrasonographic signs. Posthemorrhagic obstructive hydrocephalus was the most common complication.

Intraventricular haemorrhage in preterm infants – Can we improve outcome by addressing coagulation?

During the last few decades, the survival of preterm infants has increased dramatically. Nevertheless, with the increasing number of very young and extremely low birth weight infants, morbidity is still a major problem. Intraventricular Haemorrhage (IVH) is a major complication of preterm birth, and large haemorrhages or haemorrhages associated with parenchymal brain lesions may yield a high rate of future disability. IVH is a complex, multi-factorial disorder. Prematurity and low birth weight remain as its most important risk factors, affecting vulnerability of the germinal matrix as well as the coagulation system. Approximately 80% of IVHs occur by 72 h after birth, but a considerable proportion of IVH is already visible on the first cranial ultrasound scan within a few hours of birth. The hypothesis that a severe coagulation deficiency in the premature newborn could be a major contributing factor to IVH has been suggested, and small open label interventional studies targeting the premature coagulation system have been conducted with ethamsylate, vitamin K, fresh frozen plasma, recombinant activated factor VII and prothrombin complex concentrate. The outcome of these studies will be reviewed.

Postnatal phenobarbital for the prevention of intraventricular haemorrhage in preterm infants.

Intraventricular haemorrhage (IVH) is a major complication of preterm birth. Large haemorrhages are associated with a high risk of disability and hydrocephalus. Instability of blood pressure and cerebral blood flow are postulated as causative factors. Another mechanism may involve reperfusion damage from oxygen free radicals. Phenobarbital has been suggested as a safe treatment that stabilises blood pressure and may protect against free radicals. To determine the effect of postnatal administration of phenobarbital on the risk of IVH, neurodevelopmental impairment or death in preterm infants. We used the search strategy of the Neonatal Collaborative Review Group. The original review author (A Whitelaw) was an active trialist in this area and had personal contact with many groups in this field. He handsearched journals from 1976 (when cranial computed tomography (CT) scanning started) to October 2000; these included: Pediatrics, Journal of Pediatrics, Archives of Disease in Childhood, Pediatric Research, Developmental Medicine and Child Neurology, Acta Paediatrica, European Journal of Pediatrics, Neuropediatrics, New England Journal of Medicine, Lancet and British Medical Journal. We searched the National Library of Medicine (USA) database (via PubMed) and the Cochrane Central Register of Controlled Trials (CENTRAL, 2012, Issue 10) through to 31 October 2012. We did not limit the searches to the English language, as long as the article included an English abstract. We read identified articles in the original language or translated. We included randomised or quasi-randomised controlled trials in which phenobarbital was given to preterm infants identified as being at risk of IVH because of gestational age below 34 weeks, birthweight below 1500 g or respiratory failure. Adequate determination of IVH by ultrasound or CT was also required. In addition to details of patient selection and control of bias, we extracted the details of the administration of phenobarbital. We searched for the following endpoints: IVH (with grading), posthaemorrhagic ventricular dilation or hydrocephalus, neurodevelopmental impairment and death. In addition, we searched for possible adverse effects of phenobarbitone, for example hypotension, mechanical ventilation, pneumothorax, hypercapnia and acidosis. We included 12 controlled trials that recruited 982 infants. There was heterogeneity between trials for the outcome IVH, with three trials finding a significant decrease in IVH and one trial finding an increase in IVH in the group receiving phenobarbital. Meta-analysis showed no difference between the phenobarbital-treated group and the control group in either all IVH (typical risk ratio (RR) 0.91; 95% CI 0.77 to 1.08), severe IVH (typical RR 0.77; 95% CI 0.58 to 1.04), posthaemorrhagic ventricular dilation (typical RR 0.89; 95% CI 0.38 to 2.08), severe neurodevelopmental impairment (typical RR 1.44; 95% CI 0.41 to 5.04) or death before hospital discharge (typical RR 0.88; 95% CI 0.64 to 1.21). There was a consistent trend in the trials towards increased use of mechanical ventilation in the phenobarbital-treated group, which was supported by the meta-analysis (typical RR 1.18; 95% CI 1.06 to 1.32; typical risk difference 0.129; 95% CI 0.04 to 0.21), but there was no significant difference in pneumothorax, acidosis or hypercapnia. Postnatal administration of phenobarbital cannot be recommended as prophylaxis to prevent IVH in preterm infants and is associated with an increased need for mechanical ventilation.

Association between Sodium Intake and Intraventricular Hemorrhage in Preterm Infants

Association between Sodium Intake and Intraventricular Hemorrhage in Preterm Infants

Homocysteine levels and its association with intraventricular hemorrhage in preterm infants born to preeclamptic mothers

Objective: To investigate the relation between serum homocysteine levels and intraventricular hemorrhage (IVH) in preterm infants born to preeclamptic mothers.Method: This study included 84 preterm infants (42 born to preeclamptic mothers and 42 born to normotensive healthy mothers) who were admitted to Izmir Tepecik Training and Research Hospital Neonatology Clinic on the postnatal first day. The measurement of homocysteine levels in all samples were performed with an Immulite 2000 analyzer, using the chemiluminescence method. Cranial ultrasounds were performed on the fourth day and in the 1 month of age.Results: The mean plasma levels of homocysteine in infants born to preeclamptic mothers and in the control group were 8.2 ± 5.9 μmol/L and 5.3 ± 2.7 μmol/L, respectively. The plasma levels of homocysteine were significantly higher in the study group (p = 0.006). There was no association between the plasma homocysteine levels and IVH or other neonatal complications including necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia and mortality.Conclusion: Our data suggest that plasma levels of homocysteine are higher among infants born to preeclamptic mothers, but these high levels are not associated with IVH and other neonatal complications in preterm infants.

Detrended fluctuation analysis of blood pressure in preterm infants with intraventricular hemorrhage

Very preterm infants are at high risk of death and serious permanent brain damage, as occurs with intraventricular hemorrhage (IVH). Detrended fluctuation analysis (DFA) that quantifies the fractal correlation properties of physiological signals has been proposed as a potential method for clinical risk assessment. This study examined whether DFA of the arterial blood pressure (ABP) signal could derive markers for the identification of preterm infants who developed IVH. ABP data were recorded from a prospective cohort of 30 critically ill preterm infants in the first 1-3 h of life, 10 of which developed IVH. DFA was performed on the beat-to-beat sequences of mean arterial pressure (MAP), systolic blood pressure (SBP) and pulse interval, with short-term exponent (α1, for timescale of 4-15 beats) and long-term exponent (α2, for timescale of 15-50 beats) computed accordingly. The IVH infants were found to have higher short-term scaling exponents of both MAP and SBP (α1 = 1.06 ± 0.18 and 0.98 ± 0.20) compared to the non-IVH infants (α1 = 0.84 ± 0.25 and 0.78 ± 0.25, P = 0.017 and 0.038, respectively). The results have demonstrated that fractal dynamics embedded in the arterial pressure waveform could provide useful information that facilitates early identification of IVH in preterm infants.

Correlation factors of intraventricular hemorrhage in preterm infants and its MRI outcome

Objective To explore the role of anterior horn index (AHI) in magnetic resonance imaging (MRI) outcome after intraventricular hemorrhage (IVH) and the correlation factors of IVH in preterm infants.Methods We selected 55 preterm infants with IVH(Ⅱ-Ⅳ degree) confirmed by MRI as case group,and 55 preterm infants with normal MRI as control group,all the cases were admitted in neonatal medical wards in our hospital from January 2009 to September 2011.Then 30 infants of case group were scaned for the second time,to see if they had posthemorrhagic ventricular dilatation (PHVD) and compare the AHI with the last time MRI,and analysis the related factors associated with IVH in preterm infants.Results MRI results:9 infants had PHVD,and the AHI rised (0.36 ± 0.05 v s 0.46 ± 0.06,P ＜ 0.01);21 infants didn't have PHVD,and the AHI decreased (0.31 ± 0.02 vs 0.30 ± 0.02,P ＜ 0.01).Logistic regression analysis:vaginal delivery,use of pulmonary surfactant,mechanical ventrilator care were associated with IVH (P ＜0.05).Conclusion AHI can be used for judging PHVD in preterm infants with IVH.Preterm infants with IVH,especially grade Ⅱ should be monitored AHI.Vaginal delivery and mechanical ventrilator may be risk factor of IVH in preterm infants,while use of pulmonary surfactant may a protective factor of IVH. Key words: Intraventrieular hemorrhage; Magnetic resonance imaging; Anterior horn index; Correlation factor; Preterm infants

Long Duration of Hyperglycemia in the First 96 Hours of Life Is Associated with Severe Intraventricular Hemorrhage in Preterm Infants

To assess the association between severe intraventricular hemorrhage (IVH) and blood glucose variables during the first 96 hours of life in preterm infants. Preterm infants with IVH grade 3-4 (n = 70) were compared with matched infants of similar gestational age and birth weight, but with no IVH (n = 108). Studied variables included the frequency and duration of hyper/hypoglycemic (>6.9/<3.3 mmol/L, respectively) events, the extreme slope of an event evolution, the maximal glucose value observed, and the "hyper/hypoglycemic index" representing a weighted average of the hyper/hypoglycemic amplitude. The IVH group had significantly more hyperglycemic events (2.9 ± 1.7 vs 2.4 ± 1.8 events, P < .05) with longer duration (22.2 ± 14.2 vs 14.1 ± 12.5 hours, P < .001) and a higher hyperglycemic index (1.0 ± 0.9 vs 1.4 ± 1.0, P = .003) compared with the non-IVH controls. Respiratory distress syndrome, hypotension, and thrombocytopenia increased the adjusted OR for IVH. Hypoglycemia was not independently associated with IVH. Conversely, the increase in hyperglycemic duration was most prominently increasing the aOR for severe IVH (OR = 10.33, 95% CI = 10.0-10.6, P = .033). Longer duration of hyperglycemia in the first 96 hours of life was most strongly associated with severe IVH in preterm infants. Consequently, interventional studies to determine the selective effect of continuous control of long-lasting hyperglycemia by appropriate and timed insulin treatment on the incidence of severe IVH are warranted.

Patent Ductus Arteriosus, Low Platelets, Cyclooxygenase Inhibitors, and Intraventricular Hemorrhage in Very Low Birth Weight Preterm Infants

To assess the risk for intraventricular hemorrhage (IVH) in very low birth weight preterm infants with patent ductus arteriosus (PDA) and low platelet count with treatment with cyclooxygenase (COX) inhibitors. Diagnosis and treatment of PDA, as well as risk factors for IVH, were assessed using prospectively collected data of all infants born at a gestational age <32 weeks and with a birth weight ≤ 1500 g at Innsbruck University Hospital (January 2003-December 2009). Infants with severe thrombocytopenia (<50 × 10(9)/L) were excluded from analysis. Sixty-five (20%) of the 325 infants had IVH, and 149 (45.9%) of the 325 were treated with COX inhibitors. Treatment of PDA with COX inhibitors was not an independent risk predictor for IVH in preterm infants with platelets ≥ 100 × 10(9)/L. However, COX inhibitors amplified the risk of bleeding in the presence of moderately decreased platelets (50-99 × 10(9)/L) on days of life 2-7. Multivariable OR for IVH were 0.89 [95% CI 0.43-1.87] for patients with platelets ≥ 100 × 10(9)/L and treatment with COX inhibitors, 3.40 [95% CI 1.13-10.29] for those with moderately decreased platelets without treatment, and 53.3 [95% CI 5.9-484] for patients with both moderately decreased platelets and COX inhibitor treatment compared with those with platelets ≥ 100 × 10(9)/L and no treatment (reference group) (P < .001). In very low birth weight infants with moderate thrombocytopenia treatment with COX inhibitors increased the risk for intracerebral bleeding. Any benefits of this therapy should be carefully balanced against this potential hazard.

Treatment of hydrocephalus in premature infants with intraventricular hemorrhage - placing Omaya reservoir: A series of 30 patients

Introduction. We report a series of 30 patients with spontaneous intraventricular hemorrhage (IVH) and hydrocephalus, in which is placed subcutaneous (Omaya) tank at the University Children?s Hospital in Belgrade from March 2006 to March 2011. Results. Predictors of poor outcome in treatment in getting Omaya reservoirs are low birth weight (t=2.560, p=0.016), low Apgar score (t=3.059, p=0.005), an extended number of days on mechanical ventilation (Z=4,404 , p&lt; 0.001), the presence of peripartal asphyxia (X2=9.977, p=0.002) and cardio-respiratory arrest (X2=12.804 , p&lt; 0.001). Conclusion. The outcome of treatment of hydrocephalus caused by spontaneous intraventricular hemorrhage in premature infants is worst in perinatology. There is no consensus on the diagnosis and treatment of posthemorrhage hydrocephalus, our results suggest that the main prediction factor is preoperative condition of the child.