Infection and inflammation : This process involves microglial (brain macrophage) cell activation and cytokine release , which causes damage to a specific cell type in the developing brain called the oligodendrocyte. The oligodendrocytes are a type of supportive brain cell that wraps around neurons to form the myelin sheath, which is essential for white matter development. Intrauterine infections activate the fetal immune system, which produces cytokines (., interferon γ and TNF-α) that are toxic to premyelinating oligodendrocytes. Infections also activate microglial cells, which release free radicals. Premyelinating oligodendrocytes have immature defences against reactive oxygen species (., low production of glutathione , an important antioxidant). IVH is hypothesized to cause PVL because iron-rich blood causes iron-mediated conversion of hydrogen peroxide to hydroxyl radical, contributing to oxidative damage.
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There is also data showing that antibiotics are helpful during preterm labor for women who carry bacteria called group B streptococcus (GBS). About one in five women will carry GBS, and babies who get infected during labor and delivery can become very sick. Antibiotics can treat GBS and reduce complications of a subsequent infection in the newborn, but carry risks for the mother ( Ohlssen & Shah, 2009 ). Most care providers test women for the bacteria about a month before their due date. The test involves taking swab samples from the lower vagina and rectum. Because it can take two or three days for test results to be returned, the general practice is to go ahead and begin treating a woman for GBS before confirmation of infection if a woman is in preterm labor. Most doctors think that this presumptive treatment is justified because as many as one in four women test positive for GBS. Ampicillin and penicillin are the antibiotics most commonly used for treatment.