Periventricular Hemorrhage-Intraventricular Hemorrhage Medication

Updated: Mar 19, 2014
  • Author: David J Annibale, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Medication

Medication Summary

Pharmacological intervention in the prevention and treatment of periventricular hemorrhage–intraventricular hemorrhage (PVH-IVH) and posthemorrhagic hydrocephalus remains controversial.

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Prostaglandin inhibitors

Class Summary

These agents are postulated to perform prostaglandin synthesis inhibition. They inhibit free radical formation and accelerate maturation of germinal matrix vasculature. Indomethacin has been shown to decrease the risk of high-grade PVH-IVH. However, developmental outcomes have not been shown to be improved with the use of indomethacin prophylaxis. For this reason, the role of indomethacin in the prevention of IVH remains uncertain. Analysis of patients enrolled in a multicenter trial of indomethacin prophylaxis suggests that prophylaxis is effective in male infants and not in female infants. This remains to be confirmed through prospective evaluations.

Other members of this class of drugs have not been demonstrated to be of value in reducing the incidence of PVH-IVH.

Indomethacin (Indocin)

Controversial, but possibly indicated in patients at risk for PVH-IVH, including those < 32 weeks' gestation or those who weigh < 1250 g at birth. Among its actions, indomethacin inhibits the formation of prostaglandins by decreasing the activity of cyclo-oxygenase. Additionally, through mechanisms poorly understood, indomethacin causes maturation of the germinal matrix microvasculature. It is also associated with decreased cerebral blood flow, cerebral blood flow velocity, and cerebral blood volume, especially when rapidly administered. Alterations of oxidative metabolism are also suggested.  UNfortunately, there are conflicting data regarding long-term improvement in outcomes.

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Carbonic anhydrase inhibitors

Class Summary

These agents suppress CSF production.

Acetazolamide (Diamox)

The suppression of CSF production in slowly progressive ventricular dilation is controversial. Acetazolamide is a competitive and reversible inhibitor of carbonic anhydrase.

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