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- A1M:
- alfa-1-microglobulin
- AQP1:
- aquaporin 1
- BBB:
- blood-brain barrier
- CPE:
- choroid plexus epithelium
- CSF:
- cerebrospinal fluid
- DFX:
- deferoxamine
- GM:
- germinal matrix
- GMH:
- germinal matrix hemorrhage
- hA1M:
- human plasma alfa-1-microglobulin
- Hb:
- hemoglobin
- Hp:
- haptoglobin
- ICH:
- intracranial hemorrhage
- IGF-1:
- insulinlike growth factor 1
- IVH:
- intraventricular hemorrhage
- MMP:
- matrix metalloproteinase
- MSC:
- mesenchymal stem cell
- NKCC:
- Na/K/Cl cotransporter
- PAR:
- protease-activated receptor
- PHVD:
- posthemorrhagic ventricular dilatation
- rA1M:
- recombinant human alfa-1-microglobulin
- rEPO:
- recombinant erythropoietin
- SPAK:
- Ste20-type stress kinase
- TGF-β:
- transforming growth factor β
- TLR:
- Toll-like receptor
- VEGF:
- vascular endothelial growth factor
- WM:
- white matter
Abstract
Germinal matrix–intraventricular hemorrhage (IVH) occurs in nearly half of infants born at less than 26 weeks’ gestation. Up to 50% of survivors with IVH develop cerebral palsy, cognitive deficits, behavioral disorders, posthemorrhagic ventricular dilatation, or a combination of these sequelae. After the initial bleeding and the primary brain injury, inflammation and secondary brain injury might lead to periventricular leukomalacia or diffuse white matter injury. Potential factors that are involved include microglia and astrocyte activation, degradation of blood components with release of “toxic” products, infiltration of the brain by systemic immune cells, death of neuronal and glial cells, and arrest of preoligodendrocyte maturation. In addition, impairment of the blood-brain barrier may play a major role in the pathophysiology. A wide range of animal models has been used to explore causes and mechanisms leading to IVH-induced brain injury. Preclinical studies have identified potential targets for enhancing brain repair. However, little has been elucidated about the effectiveness of potential interventions in clinical studies. A systematic review of available preclinical and clinical studies might help identify research gaps and which types of interventions may be prioritized. Future trials should report clinically robust and long-term outcomes after IVH.
- Copyright © 2019 by the American Academy of Pediatrics
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