title: Circulatory Management Focusing on Preventing Intraventricular Hemorrhage and Pulmonary Hemorrhage in Preterm Infants.
abstract: The goal of modern neonatal care of extremely preterm infants is to reduce mortality and long-term neurological impairments. Preterm infants frequently experience cerebral intraventricular or pulmonary hemorrhage, which usually occurs within 72 hours after birth and can lead to long-term neurological sequelae and mortality. These serious hemorrhagic complications are closely related to perinatal hemodynamic changes, including an increase in the afterload on the left ventricle of the heart after the infant is separated from the placenta, and an increased preload from a left-to-right shunt caused by a hemodynamically significant patent ductus arteriosus (PDA). The left ventricle of a preterm myocardium has limited ability to respond to such an increase in afterload and preload, and this can result in cardiac dysfunction and hemodynamic deterioration. We suggest that delayed umbilical cord clamping or umbilical cord milking to maintain optimal blood pressure and systemic blood flow (SBF), careful assessment to keep the afterload at an acceptable level, and a strategy of early targeted treatment of significant PDA to improve perfusion during this critical time period may reduce or prevent these serious complications in preterm infants.
authors.affiliation: Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; Department of Pediatrics, School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: subh1168@gmail.com.
authors.forename: Bai-Horng
authors.initials: BH
authors.lastname: Su
authors.affiliation: Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; Department of Pediatrics, School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Hsiang-Yu
authors.initials: HY
authors.lastname: Lin
authors.affiliation: Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan.
authors.forename: Fu-Kuei
authors.initials: FK
authors.lastname: Huang
authors.affiliation: Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan.
authors.forename: Ming-Luen
authors.initials: ML
authors.lastname: Tsai
authors.affiliation: Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Huang
mesh_terms: D001794:Blood Pressure; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004374:Ductus Arteriosus, Patent / Q000150:complications* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D014470:Umbilical Cord
keywords: delayed umbilical cord clamping/umbilical cord milking; intraventricular hemorrhage; patent ductus arteriosus; preterm infant; pulmonary hemorrhage