A detailed retrospective analysis was made of the records of 486 preterm infants, who accounted for 5-100 of all births during 1973 and 1974. Whereas preterm delivery did not contribute to perinatal mortality in terms of stillbirth, it outweighed all other causes in terms of early neonatal deaths. Preterm birth was responsible for 85'o of the early neonatal deaths not due to lethal congenital deformities. Early neonatal mortality rates were closely linked both to gestational age and birth weight and to the reason for preterm birth. Early neonatal mortality was high (97 per 1000) when preterm labour was spontaneous, whether or not associated with maternal or fetal disease or with multiple pregnancy, but low (27 per 1000) when preterm delivery was elective. Preventing spontaneous preterm labour would considerably reduce neonatal mortality in our community.

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SUMMARY The detection of the onset of intraventricular haemorrhage (IVH) during life is a necessary preliminary to understanding the cause of this condition. In 10 infants of very low birthweight treated with serial transfusions of adult blood the proportions of transfused cells circulating after each transfusion were compared with the proportion of transfused cells found in the intraventricular clot at necropsy. This allowed the timing of IVH to be restricted retrospectively to the period between consecutive blood transfusions. In addition, the proportional changes of transfused cells produced by infusion of a known red cell mass allow changes in the babies' original red cell mass to be followed during life. A fall in this value occurred in 8 infants dying with IVH and was taken to indicate haemorrhage. Comparison of the two methods in 9 infants suggested that, while in some cases intraventricular bleeding occurs rapidly, in others it takes place over a period of time. The interval between birth and the onset of haemorrhage was directly proportional to the gestational age of the infant.

Roberton, N. R. C., and Howat, P. (1975). Archives of Disease in Childhood, 50, 938. Hypernatraemia as a cause of intracranial haemorrhage. 29 definite intracranial haemorrhages and 4 suspected ones occurred during a 25-month period during which 10 072 live infants were born. There were 4 subdural haemorrhages (all fatal), 4 isolated subarachnoid haemorrhages (2 fatal), and 21 intraventricular haemorrhages (all fatal-2 beyond the neonatal period). There was no evidence of a causal relation between intraventricular haemorrhage and either hypernatraemia or large sodium intakes. There were too few cases of other types of intracranial haemorrhage to draw any aetiological conclusions.The recent study by Simmons et al. (1974) suggested that the restricted use of sodium bicarbonate in [1970][1971] Material and methods Our routine management of sick low birthweight infants has been described (Davies et al., 1972). All such infants have indwelling umbilical arterial catheters, and because of the risk of apnoea following THAM (Roberton, 1970), sodium bicarbonate was the base routinely used. Boluses of the 8-4% solution were infused when necessary at approximately 1 ml/min to maintain pHa 7 * 325. Blood was analysed for sodium at least daily, and the sodium intake in mEq/kg per 24 h was calculated from the sodium intake in milk (Shaw, Jones, and Gunther, 1973) plus the amount given intravenously as bicarbonate or dextrose saline.We maintained our umbilical artery catheters with heparinized saline (10 ,Lm/ml). After use, catheters were cleared by infusing 50% more heparinized saline than the internal volume of the catheter; 0-1 ml of saline (containing 0-015 mEq Na) would therefore be infused every time the catheter was used. This quantity has been ignored in our calculations of sodium intake. ResultsWe examined the records of infants who were born in the hospital who had (a) developed hypernatraemia (Na > 150 mEq/l) during the neontatal period, (b) received more than 8 mEq/kg during any 24 hours in the neonatal period, (c) developed any form of ICH detected clinically or at necropsy during the neonatal period.During the study period 10 072 infants were born, and 1501 were admitted to our special care baby unit. 50 nonmalformed infants died, 44 had necropsy examinations, and 25 of these had some form of ICH. 4 were subdural haemorrhages, 2 were subarachnoid haemorrhages alone, and 19 were IVH. 2 surviving infants were diagnosed as having subarachnoid haemorrhages, and 2 other infants died later in infancy after a shunt operation for posthaemorrhagic hydrocephalus attributed to a neonatal IVH.Four of the 6 infants who did not have a necropsy examination were thought on clinical evidence to have had an IVH. The birthweights of infants with IVH are given in Table I. 14 infants developed hypernatraemia, and 38 received more than 8 mEq Na/kg per 24 h. Their birthweights are given in Table II. The inter-relation between hypernatraemia, high sodium intake, and ICH is shown in Fig. 1. 12 of the 21 infants with IVH received more...

SUMMARY Continuous measurements of arterial pressures, heart rates, respiratory movements, and respiratory rates were made from birth in 44 infants at risk from intraventricular haemorrhage (IVH). 17 babies died with IVH, in 10 of whom the event was timed objectively. Events in these babies were compared with survivors of similar birthweights, gestational ages, severity of birth asphyxia, and severity of hyaline membrane disease (HMD). IVH followed severe HMD and was associated with cessation of the babies' own respiratory efforts while on a ventilator and also with characteristic cardiorespiratory events. The minimum arterial pressure before IVH was lower than in comparable babies who survived. It is suggested that fluctuations of systemic blood pressure from initial low levels may be important in the pathogenesis of IVH. It is possible that changes in cerebral blood flow are of even greater significance.