Germinal Matrix Hemorrhage: Intraventricular Hemorrhage in Very-Low-Birth-Weight Infants The Independent Role of Inherited Thrombophilia

• Published in: Stroke (1970) Vol. 42; no. 7; pp. 1889 - 1893
• Main Authors: RAMENGHI, Luca A, FUMAGALLI, Monica, GROPPO, Michela, CONSONNI, Dario, GATTI, Loredana, BERTAZZI, Pier Alberto, MANNUCCIO MANNUCCI, Pier, MOSCA, Fabio
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.07.2011
• Subjects: Biological and medical sciences; Cerebral circulation. Blood-brain barrier. Choroid plexus. Cerebrospinal fluid. Circumventricular organ. Meninges; Cerebral Hemorrhage - diagnosis; Cerebral Hemorrhage - etiology; Factor V - genetics; Female; Fundamental and applied biological sciences. Psychology; Gestational Age; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Male; Medical sciences; Multivariate Analysis; Mutation; Neurology; Poisson Distribution; Polymorphism, Genetic; Prothrombin - genetics; Regression Analysis; Risk; Thrombophilia - complications; Thrombophilia - genetics; Vascular diseases and vascular malformations of the nervous system; Vertebrates: nervous system and sense organs; Hypercoagulability; Premature; Factor V Leiden; Pregnancy disorders; Cardiovascular disease; Infant; Hemopathy; germinal matrix intraventricular hemorrhage; Vascular disease; Very low birthweight; prothrombin mutations; Cerebrovascular disease; Human; Stroke; Nervous system diseases; risk factors; preterm infants; Cerebral disorder; Thrombophilia; Newborn diseases; Prematurity; Central nervous system disease; Risk factor; Prothrombin; Mutation; Coagulopathy; Cerebral ventricle hemorrhage
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.110.590455

The etiology of germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) is multifactorial and the role of genetic polymorphisms is unclear. The aim of this prospective study was to evaluate prothrombotic genetic mutations as independent risk factors for the development of all grades of GMH-IVH in very-low-birth-weight infants. The presence of both factor V Leiden and prothrombin gain-of-function gene mutations were prospectively assessed in 106 very-low-birth-weight infants. Infants with GMH-IVH were compared to those without GMH-IVH according to genetic and clinical characteristics. Twenty-two out of 106 infants had GMH-IVH develop (20.7%). Infants with GMH-IVH had significantly lower gestational ages and birth weights. In the multivariate Poisson regression model, the prevalence of GMH-IVH appeared to be inversely related to gestational age, with a risk ratio of 0.83 (95% CI, 0.72-0.97; P=0.02) per week. Risk ratio of GMH-IVH for carriers of either prothrombotic mutation was 2.65 (95% CI, 1.23-5.72; P=0.01), similar to the risk ratio associated with need for resuscitation at birth (2.30; 95% CI, 1.02-5.18; P=0.04). Very-low-birth-weight infants who are carriers for either prothrombotic mutations are at increased risk for development of GMH-IVH. Genetic factors act as independent risk factors of the same magnitude as other known risk factors.