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Volume 16, Issue 4, Pages 191-199 (December 2009)


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The Relationship Between Systemic Hemodynamic Perturbations and Periventricular-Intraventricular Hemorrhage—A Historical Perspective

Jeffrey M. Perlman, MB, ChBCorresponding Author Informationemail address

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.

Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY

Corresponding Author InformationAddress reprint requests to Jeffrey M. Perlman, MB, ChB, Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 E, 68th St, New York, NY 10065

PII: S1071-9091(09)00061-8

doi:10.1016/j.spen.2009.09.006


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