Prevention of Intracranial Hemorrhage

After completing this article, readers should be able to: 1. Explain how delaying or preventing preterm delivery can reduce the risk of intracranial hemorrhage (ICH). 2. Explain how the use of forceps during vaginal delivery may protect against ICH. 3. List the postnatal factors that may influence the risk of developing ICH. 4. Delineate supportive measures after birth that can minimize the risk of ICH. Intracranial hemorrhage (ICH) is a major neurologic complication in preterm infants. Its incidence is inversely related to gestational age or birthweight. Because of its multi-factorial etiopathogenesis, the “silver bullet” that will prevent ICH still does not exist. However, numerous studies have addressed various modalities for prevention of this event in both antenatal and postnatal periods. The increased risk of ICH among preterm infants may be explained by the preterm infant’s brain structure. The major feature of the immature brain is the presence or prominence of the periventricular germinal matrix, a highly vascularized structure. The germinal matrix contains capillaries with a low blood flow. Abrupt or severe changes in blood flow can disrupt endothelium and cause ICH into the tissues of the periventricular germinal matrix. Because of this unique brain morphology in preterm infants, obstetric strategies for prevention of ICH are aimed at preventing preterm deliveries. ICH is identified in more than 90% of cases by 4 to 5 days of age, but 30% to 50% of these hemorrhages are present within 12 hours of age, and it has been estimated that 40% occur as early as 1 hour of age. Preventive measures would differ for early-onset versus later-onset ICH. Antenatal measures are likely to affect early ICH, and postnatal measures probably will influence later-onset ICH. Because early-onset ICH is more likely to evolve in severity, its prevention can result in an overall decreased incidence of severe ICH. Antenatal strategies …