====== Periventricular-intraventricular hemorrhage Risk Factors ======

Increased [[cerebral perfusion pressure]] (CPP) with the associated increased [[cerebral blood flow]] (CBF) and [[hypoxia]] are the common denominators for most risk factors for [[Periventricular-intraventricular hemorrhage]] (PIVH). The elevated pressure may cause the hemorrhage by rupturing the fragile vessels of the [[germinal matrix]], possibly already damaged by previous insults of high or fluctuating [[CBF]] and hypoxia.

Risk factors for PIVH include
((Dykes FD, Lazzara A, Ahmann P, Blumenstein B, et al. Intraventricular Hemorrhage: A Prospective Evaluation of Etiopathologies. Pediatrics. 1980; 66:42–49)):

1. those associated primarily with increased CBF or CPP:

a) asphyxia: including hypercapnia 

b) rapid volume expansion

c) seizures

d) pneumothorax

e) cyanotic heart disease (including PDA)

f) infants being mechanically ventilated having RDSand fluctuating CBF velocity documented
by Doppler flow meter
((Perlman JM, McMenamin JB, Volpe JJ. Fluctuating Cerebral Blood-Flow Velocity in Respiratory Dis- tressSyndrome.NEnglJMed.1983;309:204–209))

g) anemia

h) decreased blood glucose

i) arterial catheterization

j) blood pressure fluctuations

2. younger gestational age (GA)

3. low birth weight

4. acute amnionitis

5. failure to give antenatal steroids during the 48 hours prior to pre-term delivery 
((Wirtschafter DD, Danielsen BH, Main EK, Korst LM, Gregory KD, Wertz A, Stevenson DK, Gould JB. Pro- moting antenatal steroid use for fetal maturation: results from the California Perinatal Quality Care Collaborative. J Pediatr. 2006; 148:606–612))
(i.e. to women at risk of delivering low birth-weight infants):

6. APGAR’s <4 at 1minute and <8 at 5minutes

7. acidosis

8. coagulopathies

9. general anesthesia for C-section

10. extracorporeal membrane oxygenation (ECMO): due to heparinization in addition to increased CPP

11. maternal cocaine abuse
((Volpe JJ. E ect of Cocaine Use on the Fetus. N Engl J Med. 1992; 327:399–407))

12. maternal aspirin use