Intraventricular hemorrhage: (Prevention)

Prevention 1. Antenatal corticosteroids a. Betamethasone b. Although their primary indication is to promote fetal lung maturation, antenatal corticosteroids also have been shown to reduce the risk of IVH. 2. Indomethacin a. Proposed mechanism – Cyclooxygenase-1 and -2 inhibition reduces prostaglandin production, thus decreasing cerebral blood flow; also can stimulate vascular maturation and is an antioxidant.

. Regimen – 0.1 mg/kg/dose intravenously every 24 hours x 3 doses; administered within 6–12 hours of life to neonates with a birth weight less than 1000–1250 g c. Significantly reduced the incidence of severe (grade III and IV) IVH i. Benefit not shown with ibuprofen prophylaxis ii. Also shown to reduce the risk of symptomatic PDA d. Not shown to improve long-term survival without neurodevelopmental sequelae 3. Recombinant human erythropoietin a. Proposed mechanism – Neuroprotection after brain injury (e.g., hypoxic-ischemic encephalopathy, secondary to premature birth) is facilitated by anti-inflammatory, anti-excitotoxic, antioxidant, and antiapoptotic effects on neurons and oligodendrocytes, which promote neurogenesis and angiogenesis b. High-dose regimens (1000–30,000 units/kg/dose), much higher than those previously used for anemia of prematurity, are required to achieve measurable concentrations within the brain. c. Short- and long-term clinical benefits are still under investigation.