TNF and periventricular leukomalacia: FIRS can lead to multi-organ involvement in the following body systems; it can cause hematopoietic abnormalities (60, 61), endocrine abnormalities as a result of “stress” (62, 63), cardiac dysfunction, especially diastolic (64), and brain injury in numerous mechanisms such as high tumor necrosis factor alpha (TNFα) concentrations in PVL infants (65).