Division of Neonatology, Children's Hospital at Montefiore, Bronx, NY, USA.
Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA.
Nat Rev Neurol. 2021 Apr;17(4):199-214. doi: 10.1038/s41582-020-00447-8. Epub 2021 Jan 27.
Intraventricular haemorrhage (IVH) continues to be a major complication of prematurity that can result in cerebral palsy and cognitive impairment in survivors. No optimal therapy exists to prevent IVH or to treat its consequences. IVH varies in severity and can present as a bleed confined to the germinal matrix, small-to-large IVH or periventricular haemorrhagic infarction. Moderate-to-severe haemorrhage dilates the ventricle and damages the periventricular white matter. This white matter injury results from a constellation of blood-induced pathological reactions, including oxidative stress, glutamate excitotoxicity, inflammation, perturbed signalling pathways and remodelling of the extracellular matrix. Potential therapies for IVH are currently undergoing investigation in preclinical models and evidence from clinical trials suggests that stem cell treatment and/or endoscopic removal of clots from the cerebral ventricles could transform the outcome of infants with IVH. This Review presents an integrated view of new insights into the mechanisms underlying white matter injury in premature infants with IVH and highlights the importance of early detection of disability and immediate intervention in optimizing the outcomes of IVH survivors.
脑室出血（IVH）仍然是早产儿的主要并发症之一，可导致幸存者脑瘫和认知障碍。目前尚无预防 IVH 或治疗其后果的最佳疗法。IVH 的严重程度不同，可表现为局限于室管膜下基质的出血、小至大 IVH 或脑室周围出血性梗死。中重度出血会使脑室扩张并损伤脑室周围的白质。这种白质损伤是由一系列血液引起的病理反应引起的，包括氧化应激、谷氨酸兴奋毒性、炎症、信号通路紊乱和细胞外基质重塑。目前正在临床前模型中研究 IVH 的潜在治疗方法，临床试验证据表明，干细胞治疗和/或通过内窥镜从脑室内清除血栓可能会改变 IVH 婴儿的结局。这篇综述提出了一个综合的观点，即对伴有 IVH 的早产儿白质损伤的机制有了新的认识，并强调了早期发现残疾和立即干预以优化 IVH 幸存者结局的重要性。
