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Semin Pediatr Neurol. 2009 Dec;16(4):191-9. doi: 10.1016/j.spen.2009.09.006.

The relationship between systemic hemodynamic perturbations and periventricular-intraventricular hemorrhage--a historical perspective.

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Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA.


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.

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