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 1):
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 2)
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 3) (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 4)
12. maternal aspirin use