Современные представления о факторах риска, патогенезе и профилактике внутрижелудочковых кровоизлияний

Введение. Внутрижелудочковое кровоизлияние (ВЖК) на современном этапе развития медицины остается патологией с высоким уровнем летальности и инвалидизации недоношенных новорожденных. В связи с этим выявление факторов риска развития, разработка системы профилактики, диагностики и лечения ВЖК не только медицинская, но и социально-экономическая задача.

Цель работы — анализ и обобщение новых научных данных о факторах риска, патогенезе и профилактике ВЖК у новорожденных детей.

Материалы и методы. Выполнен поиск и анализ научных работ с использованием баз данных PubMed, Cochrane Library, РИНЦ. Подбор статей проведен с использованием терминов: intraventricular hemorrhage, premature newborns, risk factors, pathogenesis, prevention. В обзор включено 78 источников, опубликованных за период с 2014 по 2025 г.

Результаты и обсуждение. В статье представлены обобщенные данные об этиологических и патогенетических механизмах развития ВЖК у недоношенных новорожденных. Последствия перенесенного ВЖК определяют необходимость разработки эффективной и безопасной стратегии профилактики этой патологии в целях снижения частоты тяжелых форм и предотвращения возможных осложнений.

Заключение. ВЖК — это состояние, возникающее вследствие особенностей строения незрелого герминативного матрикса у недоношенных новорожденных. Нетравматическое ВЖК является полиэтиологичным заболеванием, основными факторами риска которого являются внутриутробные инфекции, отслойка плаценты, затяжные роды через естественные родовые пути, асфиксия и гипоксия новорожденного, колебания артериального давления, сопутствующие заболевания новорожденных. При проведении профилактических мероприятий важен мультидисциплинарный подход. Профилактика должна быть направлена в первую очередь на уменьшение числа преждевременных родов, а также применение глюкокортикостероидов во время беременности. Для предотвращения асфиксии в родах важно своевременное оперативное родоразрешение. После рождения ребенка необходимо соблюдение лечебно-охранительного режима и адекватное назначение респираторной поддержки и лекарственных средств.

1. Piccolo B, Marchignoli M, Pisani F. Intraventricular hemorrhage in preterm newborn: Predictors of mortality. Acta Biomedica. 2022;93(2):e2022041. DOI: https://doi.org/10.23750/abm.v93i2.11187.

2. Bykova YK, Ushakova LV, Filippova EA, Sugak AB, Kirtbaya AR, Vatolin KV, et al. Hemorrhagic brain injury in premature infants: Pathogenesis and ultrasound diagnostics. Neonatology: News, Opinions, Training. 2024;12(1):47–57. (In Russ). DOI: https://doi.org/10.33029/2308-2402-2024-12-1-47-57.

3. Siffel C, Kistler KD, Sarda SP. Global incidence of intraventricular hemorrhage among extremely preterm infants: A systematic literature review. Journal of Perinatal Medicine. 2021;49(9):1017–1026. DOI: https://doi.org/10.1515/jpm-2020-0331.

4. Zhou M, Wang S, Zhang T, Duan S, Wang H. Neurodevelopmental outcomes in preterm or low birth weight infants with germinal matrix-intraventricular hemorrhage: A meta-analysis. Pediatric Research. 2024;95(3):625–633. DOI: https://doi.org/10.1038/s41390-023-02877-8.

5. Tu YF, Wang ST, Shih HI, Wu PM, Yu WH, Huang CC. Epilepsy occurrence after neonatal morbidities in very preterm infants. Epilepsia. 2019;60(10):2086–2094. DOI: https://doi.org/10.1111/epi.16340.

6. Hollebrandse NL, Spittle AJ, Burnett AC, Anderson PJ, Roberts G, Doyle LW, et al. School-age outcomes following intraventricular haemorrhage in infants born extremely preterm. Archives of Disease in Childhood. Fetal and Neonatal Edition. 2021;106(1):4–8. DOI: https://doi.org/10.1136/archdischild-2020-318989.

7. McCauley KE, Carey EC, Weaver AL, Mara KC, Clark RH, Carey WA, et al. Survival of ventilated extremely premature neonates with severe intraventricular hemorrhage. Pediatrics. 2021;147(4):e20201584. DOI: https://doi.org/10.1542/peds.2020-1584.

8. Wang Y, Song J, Zhang X, Kang W, Li W, Yue Y, et al. The impact of different degrees of intraventricular hemorrhage on mortality and neurological outcomes in very preterm infants: A prospective cohort study. Frontiers in Neurology. 2022;13:853417. DOI: https://doi.org/10.3389/fneur.2022.853417.

9. Uccella S, Parodi A, Calevo MG, Nobili L, Tortora D, Severino M, et al. Influence of isolated low-grade intracranial haemorrhages on the neurodevelopmental outcome of infants born very low birthweight. Developmental Medicine and Child Neurology. 2023;65(10):1366–1378. DOI: https://doi.org/10.1111/dmcn.15559.

10. Glukhov BM, Baydarbekova AK. Outcomes and rehabilitation potential in children with intraventricular hemorrhages in the perinatal period. S. S. Korsakov Journal of Neurology and Psychiatry. 2021;121(4):19–24. (In Russ.). DOI: https://doi.org/10.17116/jnevro202112104119.

11. Dunbar MJ, Woodward K, Leijser LM, Kirton A. Antenatal diagnosis of fetal intraventricular hemorrhage: Systematic review and meta-analysis. Developmental Medicine and Child Neurology. 2021;63(2):144–155. DOI: https://doi.org/10.1111/dmcn.14713.

12. Huang J, Meng J, Choonara I, Xiong T, Wang Y, Wang H, et al. Antenatal infection and intraventricular hemorrhage in preterm infants: A meta-analysis. Medicine. 2019;98(31):e16665. DOI: https://doi.org/10.1097/MD.0000000000016665.

13. Miao J, Ren Z, Rao Y, Xia X, Wang J, Xu F, et al. Pathological staging of chorioamnionitis contributes to complications in preterm infants. Italian Journal of Pediatrics. 2020;46(1):127. DOI: https://doi.org/10.1186/s13052-020-00895-4.

14. Farghaly MAA, Aziz HF, Puthuraya S, Abdalla A, Aly H, Mohamed MA. Placental abruption and risk for intraventricular hemorrhage in very low birth weight infants: The United States national inpatient database. Journal of Perinatology. 2024;44(10):1504–1508. DOI: https://doi.org/10.1038/s41372-024-02017-y.

15. Zhao Y, Zhang W, Tian X. Analysis of risk factors of early intraventricular hemorrhage in very-low-birth-weight premature infants: A single center retrospective study. BMC Pregnancy and Childbirth. 2022;22(1):890. DOI: https://doi.org/10.1186/s12884-022-05245-2.

16. Gamaleldin I, Harding D, Siassakos D, Draycott T, Odd D. Significant intraventricular hemorrhage is more likely in very preterm infants born by vaginal delivery: A multi-centre retrospective cohort study. The Journal of Maternal-Fetal & Neonatal Medicine. 2019;32(3):477–482. DOI: https://doi.org/10.1080/14767058.2017.1383980.

17. Costa STB, Costa P, Graça AM, Abrantes M; Portuguese National Registry of very low birth weight infants. Delivery mode and neurological complications in very low birth weight infants. American Journal of Perinatology. 2024;41(9):1238–1244. DOI: https://doi.org/10.1055/a-1815-1842.

18. Rahman S, Ullah M, Ali A, Afridi N, Bashir H, Amjad Z, et al. Fetal outcomes in preterm cesarean sections. Cureus. 2022;14(8):e27607. DOI: https://doi.org/10.7759/cureus.27607.

19. Kirtbaya AR, Ionov OV, Balashova EN, Sharafutdinova DR, Golubtsova YM, Suvorova DY, et al. Risk factors of intraventricular hemorrhages in premature infants: the results of a single-center study. Neonatology: News, Opinions, Training. 2024;12(2):8–19. (In Russ). DOI: https://doi.org/10.33029/2308-2402-2024-12-2-8-19.

20. Özek E, Kersin SG. Intraventricular hemorrhage in preterm babies. Turkish Archives of Pediatrics. 2020; 55(3):215–221. DOI: https://doi.org/10.14744/TurkPediatriArs.2020.66742.

21. Cannavò L, Rulli I, Falsaperla R, Corsello G, Gitto E. Ventilation, oxidative stress and risk of brain injury in preterm newborn. Italian Journal of Pediatrics. 2020;46(1):100. DOI: https://doi.org/10.1186/s13052-020-00852-1.

22. Andreev AV, Kharlamova NV, Shilova NA, Pesenkina AA. Risk factors for the development of intraventricular hemorrhage in preterm infants with respiratory distress syndrome. Russian Bulletin of Perinatology and Pediatrics. 2021;66(5):49–55. (In Russ). DOI: https://doi.org/10.21508/1027-4065-2021-66-5-49-55.

23. Kirtbaya AR, Ionov OV, Balashova EN, Sharafutdinova DR, Golubtsova YM, Suvorova DY, et al. Coagulation risk factors for the development and progression of intraventricular hemorrhages in premature infants in the early neonatal period. Neonatology: News, Opinions, Training. 2024;12(3):31–39. (In Russ). DOI: https://doi.org/10.33029/2308-2402-2024-12-3-31-39.

24. Davenport P, Sola-Visner M. Hemostatic challenges in neonates. Frontiers in Pediatrics. 2021;9:627715. DOI: https://doi.org/10.3389/fped.2021.627715.

25. Vesoulis ZA, Flower AA, Zanelli S, Rambhia A, Abubakar M, Whitehead HV, et al. Blood pressure extremes and severe IVH in preterm infants. Pediatric Research. 2020;87(1):69–73. DOI: https://doi.org/10.1038/s41390-019-0585-3.

26. Lampe R, Rieger-Fackeldey E, Sidorenko I, Turova V, Botkin N, Eckardt L, et al. Assessing key clinical parameters before and after intraventricular hemorrhage in very preterm infants. European Journal of Pediatrics. 2020;179(6):929–937. DOI: https://doi.org/10.1007/s00431-020-03585-9.

27. Cai Y, Jiang Y, Wang P, Zhao X, Song Y, Li X. Risk factors for early periventricular intraventricular hemorrhage in extremely low birth weight infants: A retrospective study. BMC Pediatrics. 2025;25(1):58. DOI: https://doi.org/10.1186/s12887-025-05390-5.

28. Khanafer-Larocque I, Soraisham A, Stritzke A, Al Awad E, Thomas S, Murthy P, et al. Intraventricular hemorrhage: Risk factors and association with patent ductus arteriosus treatment in extremely preterm neonates. Frontiers in Pediatrics. 2019;7:408. DOI: https://doi.org/10.3389/fped.2019.00408.

29. Maduray T, Mamdoo F, Masekela R. A retrospective study on the prevalence, severity and outcomes of intraventricular haemorrhage in infants with a low birth weight in a quarternary hospital in a low- to middle-income country. South African Journal of Child Health. 2019;13(2):56–62. Available from: https://clck.ru/3Pj63X (accessed 25 May 2025).

30. Kocherova VV, Popova NG, Shcherbak VA. Causes of intraventricular hemorrhages in extremely premature newborns and features of their early outcomes. Acta Biomedica Scientifica. 2024;9(3):179–187. (In Russ). DOI: https://doi.org/10.29413/ABS.2024-9.3.18.

31. Thornburg CD, Erickson SW, Page GP, Clark EAS, DeAngelis MM, Hartnett ME, et al. Genetic predictors of severe intraventricular hemorrhage in extremely low-birthweight infants. Journal of Perinatology. 2021; 41(2):286–294. DOI: https://doi.org/10.1038/s41372-020-00821-w.

32. Ment LR, Adén U, Lin A, Kwon SH, Choi M, Hallman M, et al. Gene-environment interactions in severe intraventricular hemorrhage of preterm neonates. Pediatric Research. 2014;75(1–2):241–250. DOI: https://doi.org/10.1038/pr.2013.195.

33. Szpecht D, Gadzinowski J, Seremak-Mrozikiewicz A, Kurzawińska G, Drews K, Szymankiewicz M. The role of FV 1691G>A, FII 20210G>A mutations and MTHFR 677C>T; 1298A>C and 103G>T FXIII gene polymorphisms in pathogenesis of intraventricular hemorrhage in infants born before 32 weeks of gestation. Child’s Nervous System. 2017;33(7):1201–1208. DOI: https://doi.org/10.1007/s00381-017-3460-8.

34. Wang F, Xu Z, Jiao H, Wang A, Jing Y. Associations between MTHFR gene polymorphisms and the risk of intracranial hemorrhage: Evidence from a meta-analysis. Brain and Behavior. 2021;11(1):e01840. DOI: https://doi.org/10.1002/brb3.1840.

35. Dzietko M, Schulz S, Preuss M, Haertel C, Stein A, Felderhoff-Mueser U, et al. Apolipoprotein E gene polymorphisms and intraventricular haemorrhage in infants born preterm: A large prospective multicentre cohort study. Developmental Medicine and Child Neurology. 2019;61(3):337–342. DOI: https://doi.org/10.1111/dmcn.13987.

36. Szpecht D, Al-Saad SR, Karbowski LM, Kosik K, Kurzawińska G, Szymankiewicz M, et al. Role of Fibronectin-1 polymorphism genes with the pathogenesis of intraventricular hemorrhage in preterm infants. Child’s Nervous System. 2020;36(8):1729–1736. DOI: https://doi.org/10.1007/s00381-020-04598-3.

37. Kosik K, Szpecht D, Karbowski Ł, Al-Saad SR, Chmielarz-Czarnocińska A, Minta M, et al. Hemangioma-related gene polymorphisms in the pathogenesis of intraventricular hemorrhage in preterm infants. Child’s Nervous System. 2023;39(6):1589–1594. DOI: https://doi.org/10.1007/s00381-023-05824-4.

38. Horsch S, Parodi A, Hallberg B, Malova M, Björkman-Burtscher IM, Hansen-Pupp I, et al. Randomized control trial of postnatal rhIGF-1/rhIGFBP-3 replacement in preterm infants: Post-hoc analysis of its effect on brain injury. Frontiers in Pediatrics. 2020;8:517207. DOI: https://doi.org/10.3389/fped.2020.517207.

39. Ley D, Hallberg B, Hansen-Pupp I, Dani C, Ramenghi LA, Marlow N, et al. rhIGF-1/rhIGFBP-3 in preterm infants: A phase 2 randomized controlled trial. The Journal of Pediatrics. 2019;206:56–65.e8. DOI: https://doi.org/10.1016/j.jpeds.2018.10.033.

40. Budalova AV, Harlamova NV, Fetisova IN, Rokotyanskaya EA, Nazarova AO, Popova IG, et al. Risk factors and features of polymorphisms of genes of the maternal hemostasis system, for predicting the development of hemorrhagic disorders in premature newborns. Modern Problems of Science and Education. 2020;(3):116. (In Russ.). DOI: https://doi.org/10.17513/spno.29838.

41. Deger J, Goethe EA, LoPresti MA, Lam S. Intraventricular hemorrhage in premature infants: A historical review. World Neurosurgery. 2021;153:21–25. DOI: https://doi.org/10.1016/j.wneu.2021.06.043.

42. Thewissen L, Naulaers G, Hendrikx D, Caicedo A, Barrington K, Boylan G, et al. Cerebral oxygen saturation and autoregulation during hypotension in extremely preterm infants. Pediatric Research. 2021;90(2):373–380. DOI: https://doi.org/10.1038/s41390-021-01483-w.

43. Shah V, Musrap N, Maharaj K, Afifi J, El-Naggar W, Kelly E, et al. Grading of intraventricular hemorrhage and neurodevelopment in preterm <29 weeks’ GA in Canada. Children. 2022;9(12):1948. DOI: https://doi.org/10.3390/children9121948.

44. Ballabh P, de Vries LS. White matter injury in infants with intraventricular haemorrhage: Mechanisms and therapies. Nature Reviews Neurology. 2021;17(4):199–214. DOI: https://doi.org/10.1038/s41582-020-00447-8.

45. Dohare P, Kidwai A, Kaur J, Singla P, Krishna S, Klebe D, et al. GSK3β inhibition restores impaired neurogenesis in preterm neonates with intraventricular hemorrhage. Cerebral Cortex. 2019;29(8):3482–3495. DOI: https://doi.org/10.1093/cercor/bhy217.

46. Argyropoulou MI, Astrakas LG, Xydis VG, Drougia A, Mouka V, Goel I, et al. Is low-grade intraventricular hemorrhage in very preterm infants an innocent condition? Structural and functional evaluation of the brain reveals regional neurodevelopmental abnormalities. American Journal of Neuroradiology. 2020;41(3):542–547. DOI: https://doi.org/10.3174/ajnr.A6438.

47. Yuan W, Tamm L, Harpster K, Altaye M, Illapani VSP, Parikh NA. Effects of intraventricular hemorrhage on white matter microstructural changes at term and early developmental outcomes in infants born very preterm. Neuroradiology. 2021;63(9):1549–1561. DOI: https://doi.org/10.1007/s00234-021-02708-9.

48. Tortora D, Lo Russo FM, Severino M, Parodi A, Massirio P, Ramenghi LA, et al. Regional impairment of cortical and deep gray matter perfusion in preterm neonates with low-grade germinal matrix-intraventricular hemorrhage: An ASL study. Neuroradiology. 2020;62(12):1689–1699. DOI: https://doi.org/10.1007/s00234-020-02514-9.

49. Sharma DR, Agyemang A, Ballabh P. Cerebral gray matter injuries in infants with intraventricular hemorrhage. Seminars in Perinatology. 2022;46(5):151595. DOI: https://doi.org/10.1016/j.semperi.2022.151595.

50. Cheng B, Ballabh P. Recovery of the brain after intraventricular hemorrhage. Seminars in Fetal & Neonatal Medicine. 2022;27(1):101224. DOI: https://doi.org/10.1016/j.siny.2021.101224.

51. Erdei J, Tóth A, Nagy A, Nyakundi BB, Fejes Z, Nagy B Jr, et al. The role of hemoglobin oxidation products in triggering inflammatory response upon intraventricular hemorrhage in premature infants. Frontiers in Immunology. 2020;11:228. DOI: https://doi.org/10.3389/fimmu.2020.00228.

52. Fejes Z, Pócsi M, Takai J, Erdei J, Tóth A, Balogh E, et al. Preterm intraventricular hemorrhage-induced inflammatory response in human choroid plexus epithelial cells. International Journal of Molecular Sciences. 2021;22(16):8648. DOI: https://doi.org/10.3390/ijms22168648.

53. Posta N, Csősz É, Oros M, Pethő D, Potor L, Kalló G, et al. Hemoglobin oxidation generates globin-derived peptides in atherosclerotic lesions and intraventricular hemorrhage of the brain, provoking endothelial dysfunction. Laboratory Investigation. 2020;100(7):986–1002. DOI: https://doi.org/10.1038/s41374-020-0403-x.

54. Canesin G, Hejazi SM, Swanson KD, Wegiel B. Heme-derived metabolic signals dictate immune responses. Frontiers in Immunology. 2020;11:66. DOI: https://doi.org/10.3389/fimmu.2020.00066.

55. Pethő D, Hendrik Z, Nagy A, Beke L, Patsalos A, Nagy L, et al. Heme cytotoxicity is the consequence of endoplasmic reticulum stress in atherosclerotic plaque progression. Scientific Reports. 2021;11:10435. DOI: https://doi.org/10.1038/s41598-021-89713-3.

56. Leijser LM, de Vries LS. Preterm brain injury: Germinal matrix-intraventricular hemorrhage and post-hemorrhagic ventricular dilatation. Handbook of Clinical Neurology. 2019;162:173–199. DOI: https://doi.org/10.1016/B978-0-444–64029-1.00008-4.

57. Handley SC, Passarella M, Lee HC, Lorch SA. Incidence trends and risk factor variation in severe intraventricular hemorrhage across a population based cohort. The Journal of Pediatrics. 2018;200:24–29.e3. DOI: https://doi.org/10.1016/j.jpeds.2018.04.020.

58. Sandoval PV, Rosales PH, Hernández DGQ, Naranjo EAC, Navarro VG. Intraventricular hemorrhage and posthemorrhagic hydrocephalus in preterm infants: Diagnosis, classification, and treatment options. Child’s Nervous System. 2019;35:917–927. DOI: https://doi.org/10.1007/s00381-019-04127-x.

59. Wu T, Wang Y, Xiong T, Huang S, Tian T, Tang J, et al. Risk factors for the deterioration of periventricular-intraventricular hemorrhage in preterm infants. Scientific Reports. 2020;10(1):13609. DOI: https://doi.org/10.1038/s41598-020-70603-z.

60. Lim J, Hagen E. Reducing germinal matrix-intraventricular hemorrhage: Perinatal and delivery room factors. Neoreviews. 2019;20(8):e452–e463. DOI: https://doi.org/10.1542/neo.20-8-e452.

61. Howes A, Hilditch C, Keir A. What clinical practice strategies have been shown to decrease incidence rates of intraventricular haemorrhage in preterm infants? Journal of Paediatrics and Child Health. 2019; 55(10):1269–1278. DOI: https://doi.org/10.1111/jpc.14613.

62. Jashni Motlagh A, Elsagh A, Sedighipoor E, Qorbani M. Risk factors and short-term complications of high-grade intraventricular hemorrhages in preterm neonates in training hospitals of Alborz. Iranian Journal of Child Neurology. 2021;15(1):47–55. DOI: https://doi.org/10.22037/ijcn.v15i1.20346.

63. Lee HS, Kim SY. Histological chorioamnionitis, antenatal steroids, and neonatal outcomes in very low birth weight infants: A nationwide study. PLoS One. 2019;14(10): e0224450. DOI: https://doi.org/10.1371/journal.pone.0224450.

64. Denicol MM, Leotti VB, Soares CRS, Hilgert JB. Early-onset neonatal sepsis as a risk factor for peri-intraventricular hemorrhage in premature infants. Revista Brasileira de Epidemiologia. 2024;27:e240013. DOI: https://doi.org/10.1590/1980-549720240013.

65. Fortmann I, Mertens L, Boeckel H, Grüttner B, Humberg A, Astiz M, et al. A timely administration of antenatal steroids is highly protective against intraventricular hemorrhage: An observational multicenter cohort study of very low birth weight infants. Frontiers in Pediatrics. 2022;10:721355. DOI: https://doi.org/10.3389/fped.2022.721355.

66. de Bijl-Marcus K, Brouwer AJ, De Vries LS, Groenendaal F, Wezel-Meijler GV. Neonatal care bundles are associated with a reduction in the incidence of intraventricular haemorrhage in preterm infants: A multicentre cohort study. Archives of Disease in Childhood — Fetal and Neonatal Edition. 2020;105(4):419–424. DOI: https://doi.org/10.1136/archdischild-2018-316692.

67. Murthy P, Zein H, Thomas S, Scott JN, Mehrem AA, Esser MJ, et al. Neuroprotection care bundle implementation to decrease acute brain injury in preterm infants. Pediatric Neurology. 2020;110:42–48. DOI: https://doi.org/10.1016/j.pediatrneurol.2020.04.016.

68. Kochan M, Leonardi B, Firestine A, McPadden J, Cobb D, Shah TA, et al. Elevated midline head positioning of extremely low birth weight infants: Effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage. Journal of Perinatology. 2019;39(1):54–62. DOI: https://doi.org/10.1038/s41372-018-0261-1.

69. Gross M, Engel C, Trotter A. Evaluating the effect of a neonatal care bundle for the prevention of intraventricular hemorrhage in preterm infants. Children. 2021;8(4):257. DOI: https://doi.org/10.3390/children8040257.

70. Chiu WT, Lu YH, Chen YT, Tan YL, Lin YC, Chen YL, et al. Reducing intraventricular hemorrhage following the implementation of a prevention bundle for neonatal hypothermia. PLoS One. 2022;17(9): e0273946. DOI: https://doi.org/10.1371/journal.pone.0273946.

71. Soleimani F, Azari N, Ghiasvand H, Shahrokhi A, Rahmani N, Fatollahierad S. Do NICU developmental care improve cognitive and motor outcomes for preterm infants? A systematic review and meta-analysis. BMC Pediatrics. 2020;20(1):67. DOI: https://doi.org/10.1186/s12887-020-1953-1.

72. Ohlsson A, Aher SM. Early erythropoiesis-stimulating agents in preterm or low birth weight infants. Cochrane Database of Systematic Reviews. 2020;(2):CD004863. DOI: https://doi.org/10.1002/14651858.CD004863.pub6.

73. Wang Y, Wu Y, Li T, Wang X, Zhu C. Iron metabolism and brain development in premature infants. Frontiers in Physiology. 2019;10:463. DOI: https://doi.org/10.3389/fphys.2019.00463.

74. Hierro-Bujalance C, Infante-Garcia C, Sanchez-Sotano D, Del Marco A, Casado-Revuelta A, Mengual-Gonzalez CM, et al. Erythropoietin improves atrophy, bleeding and cognition in the newborn intraventricular hemorrhage. Frontiers in Cell and Developmental Biology. 2020;8:571258. DOI: https://doi.org/10.3389/fcell.2020.571258.

75. Juul SE, Comstock BA, Wadhawan R, Mayock DE, Courtney SE, Robinson T, et al. A randomized trial of erythropoietin for neuroprotection in preterm infants. The New England Journal of Medicine. 2020; 382(3):233–243. DOI: https://doi.org/10.1056/NEJMoa1907423.

76. Song J, Wang Y, Xu F, Sun H, Zhang X, Xia L, et al. Erythropoietin improves poor outcomes in preterm infants with intraventricular hemorrhage. CNS Drugs. 2021;35(6):681–690. DOI: https://doi.org/10.1007/s40263-021-00817-w.

77. Arias Fernández DA, Romero Diaz HA, Figueroa Garnica AD, Iturri-Soliz P, Arias-Reyes C, Schneider Gasser EM, et al. Low and sustained doses of erythropoietin prevent preterm infants from intraventricular hemorrhage. Respiratory Physiology & Neurobiology. 2025;331:104363. DOI: https://doi.org/10.1016/j.resp.2024.104363.

78. Boskabadi H, Zakerihamidi M, Faramarzi R. The vitamin D level in umbilical cord blood in premature infants with or without intra-ventricular hemorrhage: A cross-sectional study. International Journal of Reproductive BioMedicine. 2018;16(7):429–434. DOI: https://doi.org/10.29252/ijrm.16.7.429.