Antenatal and intrapartum risk factors and modern possibilities for the prevention of intraventricular hemorrhages in premature infants: a systematic review

Over the past several decades, significant progress in neonatal care has led to marked reductions in both mortality rates and severe disabilities among preterm infants, particularly those characterized by very low birth weight (VLBW) or extremely low birth weight (ELBW). However, despite ongoing therapeutic advancements and preventive measures, the incidence of intraventricular hemorrhages (IVH) in preterm neonates — especially those with VLBW and ELBW — remains alarmingly high, with no discernible downward trend. A systematic literature search was performed across major open-access databases — Medline, PubMed, Embase, and the Cochrane Library — to identify scientific publications discussing risk factors, as well as contemporary approaches to the prevention and treatment of IVH in preterm infants, including those within the VLBW and ELBW categories. Out of an initial pool of 280 identified publications, 67 full-text articles were selected for in-depth analysis based on their alignment with the study objectives. Articles were critically appraised and categorized according to the Oxford Levels of Evidence 2.1 framework, with subsequent recommendations generated following the principles outlined in The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology The review elucidates several pertinent findings: certain gene polymorphisms implicated in coagulation, inflammatory pathways, and vascular development — along with their interaction with environmental risk factors — may contribute to an elevated susceptibility to IVH in preterm neonates (Level C evidence); the antenatal administration of glucocorticosteroids in pregnant women at risk of preterm delivery demonstrates a robust reduction in IVH incidence in their children (Level A evidence); the use of magnesium sulfate and indomethacin as tocolytic agents is not recommended for IVH prophylaxis in preterm infants (Level A evidence); assisted reproductive technologies (e.g., in vitro fertilization (IVF)), laparoscopic surgeries, and multiple pregnancies are correlated with a higher risk of IVH (Level C evidence); younger maternal age and increased maternal body mass index (BMI) independently predict the development of clinically significant IVH (Level D evidence); male neonates exhibit a consistently higher risk of IVH compared to female neonates (Level B evidence); elective caesarean section appears to reduce the likelihood of IVH in preterm neonates (Level B evidence). KEYWORDS: intraventricular hemorrhages, premature infants, prevention, antenatal and intrapartum risk factors. FOR CITATION: Gorelyshev S.K., Zaplatnikov A.L., Bogoslovskaya E.A., Dementiev A.A., Chabaidze J.L., Pogosova D.R., Smirnov D.N. Antenatal and intrapartum risk factors and modern possibilities for the prevention of intraventricular hemorrhages in premature infants: a systematic review. Russian Journal of Woman and Child Health. 2025;8(1):63–71 (in Russ.). DOI: 10.32364/2618-8430-2025-8-1-10