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Origin of intraventricular haemorrhage in the preterm infant

Origin of intraventricular haemorrhage in the preterm infant,10.1136/adc.51.9.651,Archives of Disease in Childhood,G Hambleton,J S Wigglesworth

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Origin of intraventricular haemorrhage in the preterm infant   (Citations: 84)
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A technique has been developed for the injection and stereomicroscopic examination of blood vessels in the preterm newborn brain. Using this technique it can be seen that in the immature brain there is a rich capillary bed in the germinal layer region supplied mainly by Heubner's artery. Capillary channels drain directly into the terminal vein and its main branches. Study of 19 cases with spontaneous germinal layer haemorrhage (GLH) with or without intraventricular haemorrhage (IVH) failed to show rupture of the terminal vein or germinal layer infarction. In babies of up to 28 weeks' gestation GLH developed most frequently over the body of the caudate nucleus, whereas in babies of 29 weeks' gestation or more the haemorrhages were usually over the head of the caudate nucleus. Histological study of 10 cases of GLH failed to show rupture either of arteries or veins, though evidence of rupture at a capillary-vein junction was seen in one case and masses of fibrin adjacent to the vein wall in 2 others. Injection through the carotid artery caused prominent leaks of injection mass within the germinal layer capillary bed, often adjacent to the veins. Injection through the jugular veins in 2 cases failed to rupture the terminal vein but caused multiple vein ruptures at the junction of deep and cortical venous systems. Additional small ruptures in the germinal layer occurred in one of the cases only. It is suggested that the capillaries within the germinal layer may be ruptured by a rise in arterial pressure, particularly in conditions of hypercapnia and hypoxia.
Journal: Archives of Disease in Childhood - ARCH DIS CHILD , vol. 51, no. 9, pp. 651-659, 1976
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    • ...It is located within the germinal matrix (a mass of embryonic cells lying over the caudate nucleus and present only in the fetus) which lies on the lateral walls of the lateral ventricles or brain parenchyma [...

    Lee Wei Lim, et al. Germinal Matrix Hemorrhage of Prematurity: Treatment Approaches and Ou...

    • ... has been suggested that the preferential site for hemorrhage before the 28th gestational week is at the body of the caudate nucleus (anterior choroidal artery and perforating arteries); after the 28th gestational week hemorrhage is more likely to start in the ventriculi, originating from the head of caudate nucleus (Heubner's artery territory); in the newborn at term the most common site of intracerebral bleeding is the choroid plexus ...

    R. Giuffrè, et al. Connatal (fetal) hydrocephalus: an acquired pathology?

    • ...One of the most accepted pathophysiological concepts of PIVH is that initial cerebral hypoperfusion followed by hyperperfusion during the pressure passive state of cerebral circulation leads to the breakdown of the capillary bed [14, 22]...

    Juhani U. Grönlund, et al. Elevated arterial blood pressure is associated with peri-intraventricu...

    • ...Because of the initial extension and gradual involution of the germinal matrix during fetal development, the site and frequency of SEH are different in preterm and full-term infants [23] (Fig. 6). In the full-term newborn there are only a few islands of matrix cells, as well as a compact area at the connection between thalamus and nucleus caudatus, the so-called thalamocaudate notch [19]...
    • ...In the preterm infant the germinal matrix is more extensive, and haemorrhage, often in the region of the head of the caudate nucleus, is more common [23]...

    M. Heibel, et al. Early diagnosis of perinatal cerebral lesions in apparently normal ful...

    • ...L’ipotesi prevalente basata sugli studi neuroanatomici di Hambleton e Wigglesworth [29] è che alterazioni della pressione arteriosa e del flusso ematico nel letto vascolare immaturo della matrice germinativa possano iniziare il sanguinamento...

    Carla OTTAVIANO, et al. Encefalopatia ipossico-ischemica nel neonato

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