Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Perspectives : Understanding the Pathophysiology of Intraventricular Hemorrhage in Preterm Infants and Considering of the Future Direction for Treatment

  • Young Soo Park (Department of Neurosurgery and Children's Medical Center, Nara Medical University)
  • Received : 2023.01.27
  • Accepted : 2023.02.20
  • Published : 2023.05.01
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Abstract

Remarkable advances in neonatal care have significantly improved the survival of extremely low birth weight infants in recent years. However, intraventricular hemorrhage (IVH) continues to be a major complication in preterm infants, leading to a high incidence of cerebral palsy and cognitive impairment. IVH is primarily caused by disruption of the fragile vascular network of the subependymal germinal matrix, and subsequent ventricular dilatation adversely affects the developing infant brain. Based on recent research, periventricular white matter injury is caused not only by ischemia and morphological distortion due to ventricular dilatation but also by free iron and inflammatory cytokines derived from hematoma and its lysates. The current guidelines for the treatment of posthemorrhagic hydrocephalus (PHH) in preterm infants do not provide strong recommendations, but initiating treatment intervention based on ultrasound measurement values before the appearance of clinical symptoms of PHH has been proposed. Moreover, in the past decade, therapeutic interventions that actively remove hematomas and lysates have been introduced. The era is moving beyond cerebrospinal fluid shunt toward therapeutic goals aimed at improving neurodevelopmental outcomes.

Keywords

Acknowledgement

I would like to express my sincere gratitude to Andrew Whitelaw (Professor Emeritus, Bristol University) for his valuable advice and convey my deepest respect for his outstanding and excellent work over the years.

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