Hemorrhagic-ischemic cerebral injury in the preterm infant: Current concepts
Section snippets
Periventricular-intraventricular hemorrhage
Although the overall incidence of PV-IVH appears to be declining, the occurrence of severe hemorrhage remains substantial in the tiniest of the very low birth weight population (Table 1) [1], [3], [4]. Thus, approximately 26% of infants of birth weight between 501 and 750 g and 12% between 751 and 1000 g still develop the most severe forms of hemorrhage [3]. This is highly relevant for two reasons: first, survival of infants born at the cutting edge of viability continues to increase, and
Background
PVL, which refers to necrosis of white matter adjacent to the external angles of the lateral ventricles, has long been regarded as the principal ischemic lesion of the premature infant [2]; however, recent evidence suggests that the process of injury is much more complex (see below). The true extent of injury to white matter in the premature infant remains unclear and by cranial ultrasound imaging ranges from 4% to 15% [2], [57], [72]. Part of this wide variation relates to the sonographic
Summary
PV-IVH and adjacent white matter injury remains a significant problem in the premature infant. The potential mechanisms contributing to injury are complex and involve factors related to blood flow and its regulation, as well as cellular mediators including cytokines, free radical formation, and excitotoxin release. Although a reduction in the occurrence of severe IVH can be achieved with indomethacin, it does translate into long-term neurodevelopmental benefit. This reinforces the concept of a
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