Current Concepts of Pathophysiology of Perinatal Intraventricular Hemorrhage

Abstract

The term perinatal intracranial hemorrhage now evokes from most pediatricians, neonatologists, neurologists, and pathologists the thought of intracerebral, periventricular, intraventricular hemorrhage (PIVH). PIVH occurs most commonly in premature newborns of less than 32 weeks gestational age, most of whom have suffered the respiratory distress syndrome [1][2][3][4][5][6][7][8][9]. Most affected babies have sustained some degree of perinatal asphyxia [10]. The newborns who are symptomatic usually deteriorate, either suddenly or gradually, within the first three days after birth with bulging fontanelles, abnormalities on neurologic examination, bloody spinal fluid, a greater than 10% decrease in hematocrit, hypoglychorrachia, hyperglycemia, hypotension, and manifestations of seizure activity [6,7,9].These are the cardinal signs and symptoms of PIVH, but a significant proportion of affected infants exhibit only some of them, and a number of infants with hemorrhages are asymptomatic [6]. Two evaluations by computerized tomography (CT) of newborns of less than either 1500-or 1750-gm. birthweight revealed PIVH in 40 to 43% of the cases [1][2][3][4][5][6]. Twenty-five percent of the infants studied by Papile et al, who had PIVH on CT scans, were asymptomatic by Perinatal Neurology and Neurosurgery. Edited by

Intracerebral haemorrhage: from clinical settings to animal models

“… 88 Dog models may be employed to survey risk factors for PVH/IVH. 84 Unlike those seen in humans, superficial foci of bleeding may be induced in neonatal hypoxia mouse model. 89 However, these researches are related to physiological and anatomical characteristics that allow occurrence of PVH/IVH, but not the tissue reactions.…”

“…Fluctuations in arterial and venous blood pressure can cause PVH. 84 In prematurely born rabbits (27–30 days gestation), IVH may be induced by glycerol to create intracranial hypotension. 85 86 In a newborn beagle model, injection of phenylephrine hydrochloride intravenously induces hypertension which can cause IVH.…”