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Pharmacological neuroprotection and clinical trials of novel therapies for neonatal peri-intraventricular hemorrhage: a comprehensive review

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Abstract

Peri-intraventricular hemorrhage (PIVH) is a serious condition for preterm infants, caused by traumatic or spontaneous rupture of the germinal matrix (GM) capillary network in the cerebral ventricles. It is a common source of morbidity and mortality in neonates, and risk correlates with earlier delivery, low birth weight, maternal–fetal infection, and vital sign derangements, among others. PIVH typically occurs in the first 72 h of life, and symptoms, when present, manifest most commonly within the first week of life. Prevention remains the primary goal in management, predominantly via prolonging of gestation. Current therapy protocols are center-dependent without consistent consensus guidelines, but infant positioning, homeostatic stabilization, and neuroprotection offer potential options. In this update of pharmacologic neuroprotective therapies for PIVH, we highlight commonly utilized therapies and review the investigative literature. Further multi-institutional clinical trials and basic research studies are required.

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  1. Kentucky College of Osteopathic Medicine, University of Pikeville, A: 147 Sycamore Street, Pikeville, KY, 41501, USA

    Taylor Reardon

  2. College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA

    Gretchen Koller

  3. Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA

    Michael W. Kortz, Blake Wittenberg & Todd C. Hankinson

  4. Department of Pediatric Neurosurgery, Children’s Hospital Colorado, Aurora, CO, USA

    Michael W. Kortz, Blake Wittenberg & Todd C. Hankinson

  5. Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Edwin McCray

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Conception and design of study: TR; acquisition of data: MK and TR; analysis and/or interpretation of data: MK, TR, and EM; drafting the manuscript: MK, TR, EM, and GK; revising the manuscript critically for important intellectual content: MK, BW, and TH; approval of the version of the manuscript to be published: all authors.

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Reardon, T., Koller, G., Kortz, M.W. et al. Pharmacological neuroprotection and clinical trials of novel therapies for neonatal peri-intraventricular hemorrhage: a comprehensive review. Acta Neurol Belg 122, 305–314 (2022). https://doi.org/10.1007/s13760-022-01889-1

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