Obstetric antecedents of intraventricular hemorrhage and periventricular leukomalacia in the low-birth-weight neonate

Verma, Uma; Tejani, Nergesh; Klein, Susan; Reale, M; Beneck, Debra; Figueroa, Reinaldo; Visintainer, Paul

doi:10.1016/s0002-9378(97)70485-x

Cited by 158 publications

(78 citation statements)

References 19 publications

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“…33 IVF is a known risk factor for prematurity, largely as a result of the higher occurrence of multiple pregnancies. However, in our study, controlled for birth weight and gestational age, there was no difference in the incidence of multiple pregnancies between the study and control groups, an observation consistent with previous findings, 6 and an alternative explanation is necessary. It is possible that the maternal problem preventing spontaneous pregnancy is also influencing the environmental conditions of the embryo in utero, increasing the risk of IVH.…”

Section: Discussionsupporting

confidence: 92%

“…A number of risk factors have been proposed for the development of IVH: low birth weight and gestational age, [1][2][3][4][5][6][7][8] maternal smoking, 9 breech presentation, 5 gender, 5,7,10 premature rupture of membranes, 6,11 intrauterine infection, 6,11-13 mode of delivery, 5,10,11,14,15 prolonged labor, 1,16 postnatal resuscitation and intubation, 1,7,16 transferal from one unit to another, 7,16 early onset of sepsis, 17,18 development of respiratory distress syndrome 7,11 or pneumothorax, 2 recurrent endotracheal suctioning, 1,16 metabolic acidosis and rapid bicarbonate infusion, 10,16 and high-frequency ventilation. 19 Pregnancy-induced hypertension is associated with a lower rate of IVH.…”

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confidence: 99%

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Risk Factors for Intraventricular Hemorrhage in Very Low Birth Weight Premature Infants: A Retrospective Case-Control Study

et al. 2003

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ABSTRACT. Objective. High-grade intraventricular hemorrhage (IVH) is an important cause of severe cognitive and motor neurologic impairment in very low birth weight infants and is associated with a high mortality rate. The risk of IVH is inversely related to gestational age and birth weight. Previous studies have proposed a number of risk factors for IVH; however, lack of adequate matching for gestational age and birth weight may have confounded the results. The purpose of this study was to identify variables that affect the risk of high-grade IVH, using a retrospective and case-control clinical study.Methods. From a cohort of 641 consecutive preterm infants with a birth weight of <1500 g, 36 infants with IVH grade 3 and/or 4 were identified. A control group of 69 infants, closely matched for gestational age and birth weight, was selected. Maternal factors, labor and delivery characteristics, and neonatal parameters were collected in both groups. Results of cranial ultrasound examinations, whether routine or performed in presence of clinical suspicion, were also collected. Univariate analysis and multivariate logistic regression analysis were performed.Results. High fraction of inspired oxygen in the first 24 hours, pneumothorax, fertility treatment (mostly in vitro fertilization), and early sepsis were associated with an increased risk of IVH. A higher number of suctioning procedures, a higher first hematocrit, and a relatively low arterial pressure of carbon dioxide during the first 24 hours of life were associated with a lower occurrence. In the multivariate logistic regression model, early sepsis (odds ratio [

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

Risk Factors for Intraventricular Hemorrhage in Very Low Birth Weight Premature Infants: A Retrospective Case-Control Study

et al. 2003

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“…Historically, the pathogenesis of PVL was attributed to hypoxia/ischemia of developing oligodendroglia during their most vulnerable period in the late mid-trimester (3). Recently, several epidemiological and experimental studies have implicated chorioamnionitis in the pathogenesis of PVL (1)(2)(3)(4)(5)(6)(7)(8). This association suggests that inflammation, rather than hypoxia/ ischemia, may be a primary cause of white matter injury.…”

Section: Introductionmentioning

confidence: 99%

Placental Inflammation and Fetal Hemodynamics in a Rat Model of Chorioamnionitis

et al. 2010

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ABSTRACT:The relative contributions of inflammation and ischemia to the pathogenesis of periventricular leukomalacia (PVL) have not been elucidated. We hypothesized that fetal cardiovascular function and cerebral blood flow velocity (BFV) would be decreased in a rat model of chorioamnionitis. We also tested whether placental inflammation was related to proximity to the cervix in our model of chorioamnionitis [intracervical lipopolysaccharide (LPS) or vehicle (PBS) injection]. On embryonic d 15, Sprague-Dawley rats underwent baseline maternal and fetal echocardiography, followed by LPS or PBS injection, then serial echocardiographic evaluations until embryonic day (ED) 21. One hour after birth, pups had middle cerebral artery (MCA) BFV measured. Placentas of LPS-exposed pups exhibited uniform, higher inflammation grades (p Ͻ 0.001). All fetal BFVs increased with advancing GA (p Ͻ 0.001) whereas resistance index (RI) decreased (p Ͻ 0.001). There was no difference in fetal BFV between the groups other than a reduced gestationrelated increase in descending aorta BFV in LPS-exposed rats (p Ͻ 0.05). Newborn pups exposed to LPS had lower heart rate (p ϭ 0.006) and MCA BFV (p ϭ 0.024) and higher RI (p ϭ 0.003) and pulsatility index (PI; p ϭ 0.004). In conclusion, intracervical LPS injection produces an inflammation independent of placental position, a blunted increase in gestation-related aortic BFV, and a decrease in MCA BFV in newborn pups. (Pediatr Res 68: 513-518, 2010) P eriventricular leukomalacia (PVL) describes necrosis of the white matter adjacent to the lateral cerebral ventricles, which occurs primarily among premature infants and is strongly associated with the development of cerebral palsy (1,2). Historically, the pathogenesis of PVL was attributed to hypoxia/ischemia of developing oligodendroglia during their most vulnerable period in the late mid-trimester (3). Recently, several epidemiological and experimental studies have implicated chorioamnionitis in the pathogenesis of PVL (1-8). This association suggests that inflammation, rather than hypoxia/ ischemia, may be a primary cause of white matter injury. However, because chorioamnionitis is also associated with hemodynamic alterations in the newborn premature infant (9,10), it remains possible that inflammation and ischemia both contribute to the pathogenesis of PVL in chorioamnionitis-associated preterm brain injury.Several animal models have been developed to study the pathogenesis of chorioamnionitis-associated PVL (11-14). We have shown that intracervical injection of lipopolysaccharide (LPS) to a gravid rat produces PVL-like lesions in the brains of surviving LPS-exposed pups (13,14). The lesions are characterized by apoptosis (measured by TUNEL staining) and inflammation (TNF-␣ staining) (15). Our model (13) allows the investigation of fetal hemodynamics during and after LPS exposure because a majority of the pups survive. Yet, the contribution of ischemia to white matter injury had not been studied previously in this model.The primary objective o...

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“…Multiple factors play a role in neurodevelopmental outcome of these prematurely born infants. Pregnancy-induced hypertension (PIH), chorioamnionitis, premature rupture of membranes (PROM), and maternal smoking significantly alter intrauterine conditions that lead to small for gestational age (SGA) status, and also may alter the neurodevelopmental outcome of prematurely born infants (1)(2)(3)(4)(5)(6). Mothers expected to have premature delivery are often given antenatal steroids to improve pulmonary maturity.…”

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Changes in Neurotrophin Levels in Umbilical Cord Blood From Infants With Different Gestational Ages and Clinical Conditions

et al. 2003

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Obstetric antecedents of intraventricular hemorrhage and periventricular leukomalacia in the low-birth-weight neonate

Cited by 158 publications

References 19 publications

Risk Factors for Intraventricular Hemorrhage in Very Low Birth Weight Premature Infants: A Retrospective Case-Control Study

Risk Factors for Intraventricular Hemorrhage in Very Low Birth Weight Premature Infants: A Retrospective Case-Control Study

Placental Inflammation and Fetal Hemodynamics in a Rat Model of Chorioamnionitis

Changes in Neurotrophin Levels in Umbilical Cord Blood From Infants With Different Gestational Ages and Clinical Conditions

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