Intraventricular haemorrhage (IVH) is a serious complication in premature infants. This type of bleeding may lead to serious neurological sequelae or even death. IVH is prevalent in VLBW children, with an incidence of 30%.
Recent research shows a significant relationship between low cerebral blood flow and IVH. The most common way to measure blood flow is to measure blood pressure. However, studies suggest that a more correct method is to measure the SVC (Superior vena cava) flow. The SVC flow measures the upper body blood flow, which gives a good estimation of the cerebral blood perfusion. A great number of recent studies have shown a strong link between low SVC flow, IVH, and early neonatal mortality.
SVC flow is often low within the first 24 hours of life. Hence, treatment can be started early by measuring the SVC flow. A problem is that premature infants often are treated for low blood pressure without knowing if the cerebral blood flow or perfusion is low or not. Recent studies question this treatment since they revealed a weak or no correlation between blood pressure and SVC flow.
Volume expansion and inotropes are the treatments commonly used for low SVC flow. Little research has so far been done to show the effect of this treatment on premature infants. More research is therefore needed to show whether volume expansion or inotropes is the best treatment, and which inotrope(s) should be used.