Emerging and investigational therapies for intraventricular hemorrhage in preterm infants

Germinal matrix-intraventricular hemorrhage (GM-IVH) is a major complication of prematurity that contributes significantly to mortality and long-term neurodevelopmental impairments. There are no established treatments to reverse or directly treat the established brain injury resulting from IVH. This review examines the growing evidence that IVH is not simply local destruction of tissue, but that it also triggers a long-lasting cascade of secondary events that may be mitigated with targeted interventions. Strategies may include acute interventions to enhance clot clearance and restore cerebrospinal fluid flow, followed by pharmacological and cellular therapies to mitigate secondary neurotoxicity and the progression to post-haemorrhagic hydrocephalus, by targeting iron overload, oxidative stress, and inflammation, or promoting neurorepair. Finally, we critically evaluate the translational potential of these therapies and outline future directions for research and clinical application.