The relationship between systemic hemodynamic perturbations and periventricular-intraventricular hemorrhage--a historical perspective.
Periventricular-intraventricular hemorrhage (PV-IVH) remains the major cause of injury to the developing brain. Predisposing factors include a germinal matrix with an immature vasculature, a pressure passive cerebral circulation, and hemodynamic perturbations in sick premature infants. Intact cerebral autoregulation has been documented in stable premature infants; however, it functions within a limited blood pressure range and is likely to be absent in the sick hypotensive infant, which increases the risk for PV-IVH with perturbations in blood pressure. The risk for PV-IVH is markedly increased in the absence of antenatal glucocorticoid exposure in the intubated low birthweight infant <1000 g with respiratory distress syndrome; +/- other complications. Although surfactant administration reduces the severity of respiratory distress syndrome, it has not led to a reduction in PV-IVH. Early postnatal administration of indomethacin has been associated with a reduction in PV-IVH, although this has not translated into long-term neurocognitive benefits.
Perlman
Jeffrey M
JM
Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA. jmp2007@med.cornell.edu
D001794:Blood Pressure / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000473:pathology* / Q000503:physiopathology; D002552:Cerebral Ventricles / Q000473:pathology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases