Table 1.

Neonatal risk factors in the pathogenesis of IVH.

	Major Pathogenic mechanism	Putative mechanisms*	Risk factors	Preventive measures
1.	Disturbance in CBF	1. Fluctuation in CBF	Suctioning and handling Hypercarbia, hypoxia, acidosis	No routine suctioning Optimize ventilation
			Asynchrony between infants and ventilator breathe Severe RDS	Synchronized ventilation by the use of assist control or synchronized mandatory ventilation modes.
			Patent ductus arteriosis Rapid infusion of NaHCO3	indomethacin/ibuprofen slow infusion over extended period
		2. High cerebral venous pressure	Pneumothorax, High ventilator pressure Prolonged labor	Gentle ventilation
				Individualized approach as appropriate
		3. Abnormal blood pressure	Hypotension Hypertension Sepsis Dehydration	As appropriate for the infant.
		4. Pressure passive circulation	Extreme prematurity and low birth weight (<1000g) Clinically unstable resulting from respiratory compromise, sepsis or other reasons	As appropriate for the infant.
2	inherent fragility of germinal matrix vasculature	Might be worsened by an inflammatory injury to the blood brain barrier	Hypoxic ischemic insult Sepsis	Prenatal GCs stabilizes the microvasculature by increasing: pericyte coverage, GFAP expression in astrocytes, fibronection in basal lamina
3.	Platelet and coagulation disturbances	Hemostatic failure	Thrombocytopenia Disseminated intravascular coagulopathy	Replacement of blood products

^*Correlation of mechanisms with the risk factors and preventive measures is based on available evidence and author’s speculations.