Plasma Leak From the Circulation Contributes to Poor Outcomes for Preterm Infants: A Working Hypothesis

Preterm infants are at high risk of death and disability resulting from brain injury. Impaired cardiovascular function leading to poor cerebral oxygenation is a significant contributor these adverse outcomes, but current therapeutic approaches have failed improve outcome. We re-examined existing evidence regarding hypovolemia concluded that in the preterm infant loss plasma circulation results hypovolemia; this driver instability thus oxygenation. High capillary permeability, altered hydrostatic oncotic pressure gradients, reduced lymphatic return all combine increase net capillary. Evidence presented early occurs infants, permeability gradients change way promotes rapid lymph flow, inflammation some treatment strategies may further exacerbate loss. A framework for testing hypothesis presented. Understanding mechanisms opens novel support oxygenation, replace therapies, which been shown not outcomes.