Antenatal and perinatal preventative strategies for intraventricular hemorrhage

Intraventricular hemorrhage (IVH) in newborns is a major cause of mortality and neurodevelopmental morbidity in preterm infants, particularly those with low birth weights. A strong inverse relationship exists between gestational age at delivery and the risk of intraventricular hemorrhage, reflecting the immaturity of the germinal matrix. The germinal matrix is a highly active region of the preterm brain with dense but unstable vasculature that is extremely susceptible to injury. This review examines both the pathogenesis of IVH and evidence-based strategies for its prevention. Antenatal interventions, including prevention of prematurity, maternal transfer to higher-level perinatal centers, treatment of intraamniotic infection, antenatal corticosteroids, and magnesium sulfate for neuroprotection, aid in reducing the incidence and severity of IVH. From a delivery standpoint, route of delivery, careful selection of candidates for operative vaginal delivery based on gestational age, and delayed cord clamping can all influence neonatal cerebral outcomes. Understanding IVH as a multifactorial and potentially preventable injury highlights the importance of coordinated obstetric and neonatal care to improve neurodevelopmental outcomes in preterm infants.