Ante-, peri- and postnatal factors associated with intraventricular hemorrhage in very premature infants

Poryo, Martin; Boeckh, Judith Caroline; Gortner, Ludwig; Zemlin, Michael; Duppré, Perrine; Ebrahimi‐Fakhari, Daniel; Wagenpfeil, Stefan; Heckmann, Matthias; Mildenberger, Eva; Hilgendorff, Anne; Flemmer, Andreas W.; Frey, Günter; Meyer, Sascha

doi:10.1016/j.earlhumdev.2017.08.010

Cited by 80 publications

(65 citation statements)

References 46 publications

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“…Still, low GA at birth remains the strongest risk factor for the development of severe IVH [11]. GA at birth may be an important modifier of relationships between maternal PE and infant morbidity.…”

Section: Discussionmentioning

confidence: 99%

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

2018

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Background: Very preterm (VPT) delivery after severe preeclampsia (PE) has been associated with adverse perinatal outcome. It is unclear whether fetal exposure to PE per se modifies the prevalence of neonatal morbidities associated with VPT birth. Objectives: To evaluate neonatal morbidity in VPT infants exposed to maternal PE compared to morbidity in nonexposed VPT infants. Methods: This retrospective study consisted of all inborn infants delivered before 30 gestational weeks admitted to a tertiary-level neonatal intensive care unit between 1998 and 2014: 195 infants exposed to maternal PE were compared to 957 infants without maternal PE (background group). Prevalence rates of neonatal morbidity, cerebral palsy (CP), and mortality at 2 years of age were obtained from patient records. Results: The PE group had a lower median (IQR) birth weight (795 [262] g) and a higher median gestational age (GA) (27 [3] weeks) at birth than the background group (890 [385] g and 26 [3] weeks, respectively; both p < 0.001). Exposure to maternal PE was associated with lower rates of severe intraventricular hemorrhage (IVH) (2 vs. 11%), retinopathy of prematurity requiring treatment (2 vs. 7%), mortality (9 vs. 15%), and CP (4 vs. 8%). Exposure to PE remained associated with a reduced prevalence of severe IVH (OR 0.17, 95% CI 0.05–0.57) after adjustment for GA, multiple birth, Apgar score, delivery mode, sex, and antenatal steroid treatment. Conclusion: Fetal exposure to PE is associated with a decreased rate of severe IVH following VPT birth. Studies on underlying mechanisms may provide a basis for prevention of IVH in the VPT infant.

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Section: Discussionmentioning

confidence: 99%

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

2018

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“…Persistent right-left leakage at the level of the patent ductus arteriosus (PDA) and subsequent disturbances in blood distribution within organs, may result in an increased incidence of intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP) and also BPD [30][31][32][33][34][35]. Increased blood flow through the pulmonary vessels results in damage to the capillaries of the interstitial septa, and consequently, the migration of neutrophils to interstitial tissue [11,35,36].…”

Section: Risk Factors and Pathophysiological Mechanisms Of Bpdmentioning

confidence: 99%

Pathophysiological mechanisms and pharmacological methods of prevention and treatment of bronchopulmonary dysplasia in preterm infants

Wątroba¹,

Bryda²

2019

J Pre Clin Clin Res.

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Wątroba S. J, Bryda J. Pathophysiological mechanisms and pharmacological methods of prevention and treatment of bronchopulmonary dysplasia in preterm infants. AbstractIntroduction. Bronchopulmonary dysplasia (BPD) is a respiratory disease that is characterized by long-term respiratory failure and mainly affects premature infants with low birth weight (LBW), undergoing mechanical ventilation (MV) or requiring long-term oxygen therapy. In Europe, among newborns with birth weight <1500g, the incidence of BPD is around 15%. Objective. The purpose of this review was to analyze the pathophysiological mechanisms involved in the development of BPD in premature newborns and to discuss the current possibilities of pharmacological prevention and treatment of BPD. Description of the state of knowledge. The BPD pathogenesis is multifactorial. Lung damage is the result of barotrauma and volutrauma due to high-performance MV, actions of reactive oxygen species (ROS) and infectious agents. Currently used methods of pharmacological treatment of severe forms of BPD are mainly based on systemic steroid therapy and can not be considered completely effective and free of side effects. Conclusion. Despite the widespread use of proper pharmacotherapy and dynamic development of new methods of respiratory therapy, mortality in BPD is estimated at around 10% -20%. Infants with BPD are much more exposed to respiratory infections caused by respiratory syncytial virus (RSV), which may result in the development of bronchial hyperresponsiveness and bronchial asthma. Among children with BPD there are significantly higher cognitive and behavioral deficits compared to healthy children, and cerebral palsy is also significantly more common.Abbreviations AA -arachidonic acid; AAP COFN -Committee on Foetus and Newborn of the American Academy of Pediatrics; ACTHadrenocorticotropin; ADH -vasopressin, antidiuretic hormone; ASMC -airway smooth muscle cells; BPD -bronchopulmonary dysplasia; BTN -betamethasone; CAT -catalase; CC10 -Clara cell 10 kDa protein; CLD -chronic lung disease; COXcyclooxygenase; CPAP -continuous positive airway pressure; CPS FNC -Fetus and Newborn Committee of the Canadian Pediatric Society; DEX -dexamethasone; ELBW -extremely low birth weight; ENA-78 -epithelial protein activating neutrophils; EURAIL -Europe Against Immature Lung; FC -fludrocortisone; FiO 2 -oxygen concentration in the breathing mixture; FTP -fluticasone propionate; GCSs -glucocorticosteroids; GM-CSF -granulocyte and macrophage colonystimulating factor; GPx -glutathione peroxidase; HC -hydrocortisone; HO . -hydroxyl radical; HO 2 . -hydroperoxide radical; IFN-γ -gamma interferon; ILs -interleukins; IRDS -respiratory distress syndrome; IUGR -intrauterine growth retardation; IVH -intraventricular haemorrhage; LBW -low birth weight; LTs -leukotrienes; MAS -meconium aspiration syndrome; MIP-1 -macrophage inflammatory protein-1; MMPs -metalloproteinases; MRI -magnetic resonance imaging; MV -mechanical ventilation; n-CPAP -continuous positive airway pressure -nasal metho...

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“…According to studies [2][3][4], the most important role is played by the deficient and immature cerebral autoregulation, leading to significant fluctuations in the cerebral blood flow (CBF), as a result of which the fragile, muscle-lacking blood vessels of the GM are destroyed. But also various inflammatory diseases that affect the deformability of red blood cells, as well as coagulation disorders were found to be associated with the occurrence of IVH [5,6].…”

Section: Introductionmentioning

confidence: 99%

Machine learning models for identifying preterm infants at risk of cerebral hemorrhage

et al. 2020

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Intracerebral hemorrhage in preterm infants is a major cause of brain damage and cerebral palsy. The pathogenesis of cerebral hemorrhage is multifactorial. Among the risk factors are impaired cerebral autoregulation, infections, and coagulation disorders. Machine learning methods allow the identification of combinations of clinical factors to best differentiate preterm infants with intra-cerebral bleeding and the development of models for patients at risk of cerebral hemorrhage. In the current study, a Random Forest approach is applied to develop such models for extremely and very preterm infants (23-30 weeks gestation) based on data collected from a cohort of 229 individuals. The constructed models exhibit good prediction accuracy and might be used in clinical practice to reduce the risk of cerebral bleeding in prematurity.

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Ante-, peri- and postnatal factors associated with intraventricular hemorrhage in very premature infants

Cited by 80 publications

References 46 publications

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

Pathophysiological mechanisms and pharmacological methods of prevention and treatment of bronchopulmonary dysplasia in preterm infants

Machine learning models for identifying preterm infants at risk of cerebral hemorrhage

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