Intraventricular Hemorrhage in Preterm Infants: Pathogenesis
Authors: Alexa Scarcello Reviewers: Nicola Adderley Jennifer Unrau* * MD at time of publication
Abbreviations:
CBF: cerebral blood flow GM: germinal matrix
Germinal matrix: highly cellular and richly vascularized layer of the developing brain responsible for neuron and glial development in fetus; involutes by term
Prematurity <32wk Birth weight <1500g Mechanical ventilation Pneumothorax Neonatal transport Extensive resuscitation Use of hyperosmolar fluids Risk factors in preterm infants Coagulopathy Hemodynamic instability Respiratory distress syndrome Immature basal lamina Few pericytes Decreased glial fibers Poorly developed structural support of blood vessels Blood vessels within GM are simple, endothelial-lined vessels larger than mature capillaries Impaired autoregulation of cerebral blood flow due to prematurity of brain development Inability to maintain constant cerebral blood flow during changes in systemic pressure (pressure passive system) ↑ susceptibility to ischemia/reperfusion injury GM capillary network is prone to hemorrhage Hemorrhage in germinal matrix capillary bed, which drains into venous system Intraventricular Hemorrhage hemorrhage in periventricular subependymal germinal matrix Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published November 20, 2018 on www.thecalgaryguide.com