الفهرس 
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Abstract
Germinal matrix hemorrhage–intraventricular hemorrhage (GMH-IVH) is one of the main complications in preterm infants. Despite advances in modern neonatal care, its incidence remains high as a result of survival of more premature infants.
Prematurity is the most important risk factor of GMH-IVH. However, other risk factors have been implicated in the development of hemorrhage, including respiratory distress syndrome, mechanical ventilation, the need for resuscitation and inotropic support.
Transcranial Doppler (TCD) ultrasonography has been extensively performed in preterm infants to evaluate alterations in cerebral hemodynamics, and studies in the literature have suggested that systolic and diastolic flow velocities of the anterior cerebral artery are related to physio-pathological mechanisms of hemorrhages and hypoxic-ischemic events.
Cerebral blood flow (CBF) in unhealthy preterm newborns is not auto-regulated, being therefore correlated to any change in systemic blood flow. During the early transitional period, the use of left or right ventricular output for measurement of systemic blood flow may not be accurate because of blood shunting across the patent ductus arteriosus (PDA) and foramen ovale. Consequently, measurement of cardiac input via the superior vena cava (SVC) has been suggested as a proxy for global central blood flow in the transitional period.
The aim of this study was to detect the effect of low superior vena cava (SVC) flow within the first day of life on the development of IVH in preterm infants. It was conducted on (127) preterm infants that fulfill the eligibility criteria and delivered at Alexandria University Maternity Hospital (AUMH) whose gestational age was ≤ 32 weeks and birth weight ≤ 1500 grams.
First, we aimed to identify the parameters that can predict IVH development in preterm infants by categorizing the sample into two main groups: IVH group (n=71) and no IVH group (n=56). In addition, the effect of different variables on SVC flow was tested by subdividing the recruited infants into another two groups: low SVC flow group (n=44) and normal SVC flow group (n=83).
In the current study, we found that low SVC flow (< 41 ml/kg/min) was significantly associated with IVH with a p value of 0.002 in the univariate logistic regression analysis. Moreover, it was the only variable that was found to be significantly associated with IVH development in the multivariate analysis with a p value of 0.038. It is worth mentioning that, lower SVC flow and higher ACA RI were found to be significantly associated with catastrophic IVH with a p value of 0.025 and 0.023, respectively