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American Academy of Pediatrics
Article

Reducing Germinal Matrix-Intraventricular Hemorrhage: Perinatal and Delivery Room Factors

Jina Lim and Eunice Hagen
NeoReviews August 2019, 20 (8) e452-e463; DOI: https://doi.org/10.1542/neo.20-8-e452
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Jina Lim
*Neonatal-Perinatal Medicine Division, Children’s Hospital of Orange County, Orange, CA
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Eunice Hagen
†Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
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  • Abbreviations:
    ACOG:
    American College of Obstetricians and Gynecologists
    CO2:
    carbon dioxide
    CS:
    cesarean section
    DCC:
    delayed cord clamping
    ELBW:
    extremely low birthweight
    Fio2:
    fraction of inspired oxygen
    GMH:
    germinal matrix hemorrhage
    ICC:
    immediate cord clamping
    IVH:
    intraventricular hemorrhage
    NICHD:
    National Institute of Child Health and Human Development
    NIRS:
    near-infrared spectroscopy
    NRN:
    Neonatal Research Network
    SpO2:
    oxygen saturation
    UCM:
    umbilical cord milking
    VLBW:
    very low birthweight
  • Abstract

    Germinal matrix hemorrhage–intraventricular hemorrhage (IVH) is the most common form of brain injury in preterm infants. Although severe IVH has declined over the years, it still affects approximately 6% of infants born before 32 weeks of gestation. Most IVH cases are detectable by the first 24 hours after birth; therefore interventions to prevent IVH should focus on antenatal management for pregnant women and delivery room management. Obstetrical interventions, including antenatal corticosteroids, maternal rather than infant transport, and possibly elective cesarean delivery have been associated with a decreased risk of IVH. Neonatal interventions in the delivery room, including delayed cord clamping or umbilical cord milking, maintaining normothermia, avoiding fluctuations in cerebral blood flow, and optimal ventilation management are associated with a decreased risk of IVH. Multiple clinical trials are under way to further identify IVH risk factors, ability to monitor or predict IVH, and ideally prevent IVH altogether. This discussion will focus on reviewing current obstetric and neonatal management practices and their associations with germinal matrix hemorrhage–IVH.

    • Copyright © 2019 by the American Academy of Pediatrics

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    1 Aug 2019
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    Reducing Germinal Matrix-Intraventricular Hemorrhage: Perinatal and Delivery Room Factors
    Jina Lim, Eunice Hagen
    NeoReviews Aug 2019, 20 (8) e452-e463; DOI: 10.1542/neo.20-8-e452

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    Reducing Germinal Matrix-Intraventricular Hemorrhage: Perinatal and Delivery Room Factors
    Jina Lim, Eunice Hagen
    NeoReviews Aug 2019, 20 (8) e452-e463; DOI: 10.1542/neo.20-8-e452
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    • Article
      • Abstract
      • Practice Gaps
      • Objectives
      • Background
      • Antenatal Glucocorticoids
      • Maternal Transport
      • Delivery Mode and Timing
      • Additional Maternal Considerations
      • Delayed Cord Clamping
      • Hypothermia
      • Oxygenation
      • Cerebral Blood Flow
      • Intubation
      • Head Positioning
      • Conclusion
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