The protease threshold: a conceptual framework for germinal matrix hemorrhage

This manuscript presents a conceptual framework for germinal matrix hemorrhage in preterm infants, proposing a unified protease–resilience model linking inflammatory amplification to structural vascular vulnerability in the developing germinal matrix. The work synthesizes current experimental and clinical evidence to define a mechanistic threshold-based model with implications for biomarker development and preventive strategies. This manuscript is currently under peer review at Trends Open. The present version is shared as a preprint to facilitate open scientific exchange and establish public accessibility of the framework during the review process.