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PAI-1/t-PA ratio in cord blood: a potential index of brain haemorrhage risk in extreme preterms
  1. Philippe Leroux1,
  2. Stéphane Marret1,2
  1. 1Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Région Haute-Normandie-INSERM team ERI-28, Institute for Research and Innovation in Biomedicine, University of Rouen, Rouen, France
  2. 2Department of Neonatal Paediatrics and Intensive Care, Rouen University Hospital, Rouen, France
  1. Correspondence to Professor Stéphane Marret, Service de Pédiatrie Néonatale et de Réanimation, CHU Charles Nicolle, 1 rue de Germont, Rouen 76000, France; stéphane.marret@chu-rouen.fr

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Although the incidence of subependymal haemorrhage/intraventricular haemorrhage (IVH)/intraparenchymal haemorrhage has decreased in recent years, it remains a good predictor of neurodevelopmental handicaps in very-preterm infants.1 Intraventricular blood leakage can result in hydrocephalus due to limited cerebrospinal fluid resorption, a consequence of fibrosis in the arachnoid granulation, subependymal basal lamina and perivascular spaces. The reference treatment approved for hydrocephalus is the ventriculoperitoneal shunt. A randomised trial of an alternative treatment procedure combining drainage and intraventricular fibrinolysis with recombinant tissue plasminogen activator (rt-PA) has been stopped because of haemorrhagic complications.

t-PA binds to low-density lipoprotein (LDL)-related receptor protein-1 (LRP1) promoting the induction of matrix metalloproteinase (MMP) 9. In addition, t-PA cleavage of plasminogen initiates proteolytic MMP cascade, resulting in degradation of …

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