Inflammation and RDS associated with IVH

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The epidemiology of intraventricular hemorrhage (IVH) in preterm infants has always been puzzling. IVH is most frequently detected in the first day of life. Although IVH may become more severe at later times, a new IVH is unusual after 2-3 days of life. This early occurrence has been associated with vaginal birth and low blood pressures soon after birth, and with increased severity of illness of the infant. Prenatal corticosteroids increase blood pressure, decrease RDS, and decrease IVH. RDS (lung immaturity) or its management cause the recruitment of inflammatory cells to the lungs, activation of clotting systems, and increased inflammatory mediators in the airspaces.

Krediet et al report a correlation between RDS, increased levels of the pro-inflammatory mediators IL-6, IL-8, and the oxidant byproduct malondialdehyde in plasma within 12h of age and IVH detected within the first 24h of birth. There were no such correlations with IVH that occurred after 24h of age. The associations between systemic inflammation, RDS, and early IVH remain hypothesis-generating observations as to why IVH occurs.