Timing and Antecedents of Intracranial Hemorrhage in the Newborn

McDonald, Marilyn M.; Koops, Beverly L.; Johnson, Michael L.; Guggenheim, Mary Anne; Rumack, Carol M.; Mitchell, Sharon; Hathaway, William E.

doi:10.1097/00006254-198502000-00012

Cited by 19 publications

(29 citation statements)

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“…Multiple class II studies performed before 1990 suggested that Ͼ90% of all IVH cases in VLBW PT infants were detected during postnatal days 4 to 5. [45][46][47][48] Data from recent class II studies are shown in table 2 (see the electronic version of this article for table 6 at www.neurology.org). In one study, 28 248 infants with BW of Ͻ1,500 grams underwent regular US at predefined times (1-5 days, 10 -14 days, 28 days, and term).…”

Section: Whichmentioning

confidence: 99%

Practice parameter: Neuroimaging of the neonate: [RETIRED]

Ment

Bada²,

Barnes³

et al. 2002

Neurology

393

100

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Article abstract-Objective: The authors reviewed available evidence on neonatal neuroimaging strategies for evaluating both very low birth weight preterm infants and encephalopathic term neonates. Imaging for the preterm neonate: Routine screening cranial ultrasonography (US) should be performed on all infants of Ͻ30 weeks' gestation once between 7 and 14 days of age and should be optimally repeated between 36 and 40 weeks' postmenstrual age. This strategy detects lesions such as intraventricular hemorrhage, which influences clinical care, and those such as periventricular leukomalacia and low-pressure ventriculomegaly, which provide information about long-term neurodevelopmental outcome. There is insufficient evidence for routine MRI of all very low birth weight preterm infants with abnormal results of cranial US. Imaging for the term infant: Noncontrast CT should be performed to detect hemorrhagic lesions in the encephalopathic term infant with a history of birth trauma, low hematocrit, or coagulopathy. If CT findings are inconclusive, MRI should be performed between days 2 and 8 to assess the location and extent of injury. The pattern of injury identified with conventional MRI may provide diagnostic and prognostic information for term infants with evidence of encephalopathy. In particular, basal ganglia and thalamic lesions detected by conventional MRI are associated with poor neurodevelopmental outcome. Diffusion-weighted imaging may allow earlier detection of these cerebral injuries. Recommendations: US plays an established role in the management of preterm neonates of Ͻ30 weeks' gestation. US also provides valuable prognostic information when the infant reaches 40 weeks' postmenstrual age. For encephalopathic term infants, early CT should be used to exclude hemorrhage; MRI should be performed later in the first postnatal week to establish the pattern of injury and predict neurologic outcome.

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Section: Whichmentioning

confidence: 99%

Practice parameter: Neuroimaging of the neonate: [RETIRED]

Ment

Bada²,

Barnes³

et al. 2002

Neurology

393

100

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“…Intubation, if performed without preprocedural sedation and analgesia, is associated with pain and adverse physiologic responses, including hypoxia, bradycardia, systemic and intracranial hypertension, [1][2][3][4] and a potential risk of intraventricular hemorrhage in preterm infants. [5][6][7] Premedication has the potential to attenuate these potentially deleterious physiologic responses, is more humane, and has a growing body of evidence that it not only improves the physiologic stability but also decreases the time and difficulty of the procedure. 3,4,8,9 As far back as 1992, Ziegler and Todres 10 performed a preliminary survey to determine the extent and type of premedication used for intubation.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] In extremely preterm infants, sudden elevation of intracranial pressure and systemic hypertension can contribute to intraventricular bleeding. [5][6][7] The unfavorable physiologic changes in heart rate, oxygen saturation, blood pressure, and intracranial pressure may be the expression of accompanying pain, and probably reflect autonomic overactivity. A recent meta-analysis of nine randomized controlled trials and two cohort studies related to the effectiveness and potential adverse effects of premedication for endotracheal intubation in newborns by Shah et al 11 concluded that 'overall, premedication appears beneficial, either in attenuating the adverse physiologic responses to the intubation or decreasing the duration of the procedure, and its use is recommended.'…”

mentioning

confidence: 99%

Are newborns receiving premedication before elective intubation?

et al. 2006

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Aims: To determine the extent and type of premedication used for elective endotracheal intubation in neonatal intensive care units (NICUs).Methods: A pretested questionnaire was distributed via e-mail to the program directors of the neonatology divisions with accredited fellowship programs in Neonatal-Perinatal Medicine in the United States.Results: Of the 100 individuals contacted, 78 (78%) participated in the survey. Only 34 of the 78 respondents (43.6%) always use any premedication for elective intubation. Nineteen respondents (24.4%) reported to have a written policy regarding premedication. Morphine or fentanyl was used most commonly (57.1%), with a combination of opioids and midazolam or other benzodiazepines used less frequently. Fourteen respondents (25%) also use muscle relaxants with sedation for premedication, but only nine respondents combined paralysis with atropine and sedation.Conclusion: Most neonatology fellowship program directors do not report always using premedication for newborns before elective endotracheal intubation despite strong evidence of physiologic and practical benefits. Only a minority of the NICUs has written guidelines for sedation, which may preclude effective auditing of this practice. Educational interventions may be necessary to ensure changes in clinical practice.

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“…5 The incidence of GMH/TVH increases with decreasing gestational age and, independent of gesta-tional age s34 weeks, the "risk period" for hemorrhage has been reported to be the first 3-4 postnatal days (PNDs). 9 - 15 Although it is tempting to speculate thaf this risk period is simply related to immediate perinatal events, clinical data suggest other contributing factors. 1 - 15 Respiratory distress syndrome, pneumothoraces, and seizures, all of which have been shown to be related to GMH/TVH, 1 ' 15 increase in frequency during the first postnatal week.…”

mentioning

confidence: 99%

Beagle pup germinal matrix maturation studies.

Ment

Stewart

Ardito

et al. 1991

Stroke

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Intraventricular hemorrhage, or hemorrhage into the germinal matrix tissues of the developing brain, remains a common problem of preterm infants. The "risk period" for this insult is the first 3 -4 postnatal days. We hypothesized that this risk period for hemorrhage is related to rapid perinatal maturation of the germinal matrix vasculature and employed the newborn beagle pup model for the study of this maturation. Newborn beagle pups ( R = 3 0 ) were anesthetized and systemically perfused with buffered formalin; the brains were removed and prepared for immunohistochemical study. Sections stained with Bandeiraea lectin demonstrated that there was no difference in germinal matrix vessel density between postnatal days 1 and 4. Germinal matrix sections were also stained for antibodies to a-smooth muscle actin, collagen IV, collagen V, desmin, factor Mil-related antigen, nbronectin, glial fibrillary acidic protein, laminin, transferrin, and vimentin. Vasculature staining by a-smooth muscle actin was not noted until postnatal day 10, and differential staining was detected for antibodies to laminin and collagen V. Quantification of staining intensity by confocal microscopy demonstrated a significant increase in both extracellular matrix components at postnatal day 4 compared with day 1 (p<0.05 for both). These basement membrane proteins may add sufficient structural integrity to germinal matrix vessels to prevent capillary rupture and thus intraventricular hemorrhage. (Stroke 1991^2:390-395)

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Timing and Antecedents of Intracranial Hemorrhage in the Newborn

Cited by 19 publications

References 0 publications

Practice parameter: Neuroimaging of the neonate: [RETIRED]

Practice parameter: Neuroimaging of the neonate: [RETIRED]

Are newborns receiving premedication before elective intubation?

Beagle pup germinal matrix maturation studies.

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