Strategies for prevention of intraventricular hemorrhage in the neonatal intensive care unit.

Intraventricular hemorrhage (IVH) is a major cause of mortality and morbidity in preterm infants. As there are no curative treatments for IVH, prevention is the cornerstone of management. A review of the pathogenesis of IVH suggests that interventions that limit disruptions in cerebral blood flow in the first week after birth are the most effective. Evidence-base strategies to prevent IVH after admission to the nursery include: (1) management of preterm respiratory distress syndrome with less invasive surfactant administration, permissive hypercapnia, and volume-targeted ventilation; (2) systematic screening of at-risk preterm infants with targeted neonatal echocardiography for early detection of hemodynamic impairment and provision of individualized cardiovascular support; (3) prophylactic indomethacin; (4) multifaceted approach to prevention of physiologic stressors including early and routine use of kangaroo care. Although reducing rates of IVH may be desirable, the overall benefits and risks need to be considered before implementing any strategy routinely.