Clinical Events Relating to Intraventricular Haemorrhage in the Newborn

Abstract

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.

Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks’ gestation: a randomised controlled trial

“…Although late clamping also induces a rapid volume expansion, this procedure was associated with a lower incidence of IVH 22 23. Several reports have emphasised the importance of initial hypotension as an IVH-inducing factor 28 – 30. The blood pressure in the milked group was higher than in the control group.…”

Hypertensive Peaks in the Pathogenesis of Intraventricular Hemorrhage in the Newborn. Abolition by Phenobarbitone Sedation

“…The effect of phenobarbitone sedation on motor activity and MABP pressure peaks was tested on 5 infants not eligible for the main study (birth weight > I 500 8). It was found that phenobar- tension (9) and low cerebral blood flow (10) are associated with a high infant morbidity and mortality. The contrasting apparently good prognosis of the IVH infants in the present study suggests that, although elevations of BP may lead to IVH, the extent of the injury may be less severe in the absence of preceding hypotension.…”

Determinants of Cerebral Fractional Oxygen Extraction Using Near Infrared Spectroscopy in Preterm Neonates

“…The final part of this study investigated the interaction between blood pressure and cerebral FOE. Hypotension in preterm neonates has been associated with a poor outcome in terms of mortality and morbidity (Bada et al, 1990; Fujimara et al, 1979; Miall-Allen et al, 1987; Szymonowicz et al, 1984; Watkins et al, 1989). The rationale for the therapeutic support of blood pressure is based on the assumption that a low blood pressure is associated with low systemic blood flow (Miall-Allen and Whitelaw, 1989; Report of Joint Working Group, 1992) and therefore impairs oxygen delivery to the tissues.…”