Circulating adrenomedullin is increased in preterm newborns developing intraventricular hemorrhage

Adrenomedullin is a novel vasoactive peptide that participates in cerebral blood flow regulation and circulates in human plasma. To verify whether pla sma adrenomedullin is able to identify preterm newborns at risk of intraven tricular hemorrhage (IVH), we performed a case-control study. Plasma sample s collected within 6 h after birth in 24 preterm newborns who developed IVH , as diagnosed at 72 h, were assessed for adrenomedullin and compared with those obtained from 48 preterm. newborns, matched for gestational age, who, did not develop IVH. Cerebral ultrasound and Doppler velocimetry waveform. patterns in the middle cerebral artery were also recorded at the time of b lood sampling. Adrenomedullin blood concentrations and middle cerebral arte ry pulsatility index values were significantly higher in infants developing IVH (20.1 +/-4.5 fmol/mL and 1.71 +/-0.21 fmol/mL, respectively) than in c ontrols (7.5 +/-3.0 fmol/mL and 1.49 +/-0.19 fmol/mL, respectively). Adreno medullin blood concentrations correlated with middle cerebral artery pulsat ility index (r=-0.77, p<0.01) and with the. grade of IVH extension (r=0.83, p<0.01). This study suggests that adrenomedullin blood concentration might be a promising tool for identifying preterm infants at risk of IVH immedia tely after birth, when imaging assessment and clinical symptoms of hemorrha ge are still silent.