Intraventricular haemorrhage in the preterm infant without hyaline membrane disease

The clinicopathological associations of 33 singleton infants who died with intraventricular haemorrhage (IVH) without hyaline membrane disease (HMD) ('IVH only') were compared with those of 39 infants who died with IVH+HMD over the same gestation range in order to determine what factors other than those related to HMD may contribute to the pathogenesis of IVH. The incidence of 'IVH only' was inversely related to gestational age in the Hammersmith birth population, whereas the incidence of IVH+HMD rose to a peak at 28-29 weeks' gestation. Infants with 'IVH only' lived longer on average than those with IVH+HMD despite a lower birthweight and shorter gestation. Infants who died in the first 12 hours from 'IVH only' had suffered severe birth asphyxia but in those who died later the main symptom was recurrent apnoea. Fewer infants with asphyxia but in those who died later the main symptom was.recurrent apnoea. Fewer infants with 'IVH only' were given alkali therapy or were connected to the ventilator as compared to those with IVH+HMD, but there were no differences in alkali therapy in those who lived for 12 hours or more. In the 'IVH only' group there was a high incidence of haemorrhage from other sites and of bacterial infections. It is suggested that, in the absence of HMD, extreme immaturity is the main factor determining the occurrence of IVH. Birth asphyxia, apnoeic attacks, haemorrhage, and infections may play subsidiary roles, possibly through development of metabolic acidosis.     

围生因素与新生儿肺透明膜病发病关系的探讨

目的探讨围生因素与新生儿肺透明膜病(HMD)发病的关系。方法对481例早产儿围生因素进行Logistic回归分析,筛选出与HMD有关的因素,列出回归方程,然后对其进行率的比较及卡方检验。结果HMD危险因素的主效应模型是logit(p)=6.254-0.204胎龄-1.556出生体重 0.834窒息/宫内窘迫 1.635胎膜早破。对于有围生期合并症的早产儿,其胎龄越小,HMD发病率越高。结论30周以下早产儿HMD发病主要与胎龄、出生体重关系密切,而30周以上早产儿HMD发病除与胎龄、出生体重有关外,还与围生因素密切相关,其发病机制有待进一步研究。     

Intraventricular hemorrhage in the preterm infant

Intraventricular hemorrhage (IVH) is a common neonatal morbidity among premature infants which is diagnosed by cranial ultrasound in the newborn special care unit. Although very premature infants are more likely to experience the highest grades of hemorrhage, a number of perinatal and postnatal events have been shown to be associated with it's occurence. Factors such as vaginal delivery, labor, and intrapartum asphyxia have been associated with early onset of hemorrhage, whereas antenatal exposure to steroids may be protective. Respiratory Distress Syndrome has also been associated with hemorrhage. Since infants with a history of IVH have increased mortality rates and are at increased risk of seizures, periventricular leukomalacia, hydrocephalus, and neurodevelopmental handicap, many investigators have studied management techniques and pharmacologic interventions to decrease the incidence of IVH, including muscle paralysis, phenobarbital, Vitamin E, indomethacin, ethamsylate and surfactant. Our investigations have shown that low dose indomethacin (0.1 mg/kg i.v.) at 6–12 postnatal hours and every 24 h for two more doses decreases the incidence of all grades of IVH within the first 5 days of life. Although tremendous progress has been made in the understanding of the pathogenesis and prevention of IVH, innovative animal and human studies are needed to further reduce the incidence of this important neonatal morbidity.     

Air embolism and pulmonary interstitial emphysema in a preterm infant with hyaline membrane disease

A preterm infant with severe hyaline membrane disease requiring extreme mechanical ventilation developed pulmonary air leaks with consecutive shock. The chest roentgenogram showed bilateral pulmonary interstitial emphysema and gas within the heart silhouette as well as in the hepatic veins, inferior v. cava, portal vein, and many abdominal vessels. The respiratory and circulatory failure by massive systemic gas embolism resulted in death.     

Origin of intraventricular haemorrhage in the preterm infant.

A technique has been developed for the injection and stereomicroscopic examination of blood vessels in the preterm newborn brain. Using this technique it can be seen that in the immature brain there is a rich capillary bed in the germinal layer region supplied mainly by Heubner''s artery. Capillary channels drain directly into the terminal vein and its main branches. Study of 19 cases with spontaneous germinal layer haemorrhage (GLH) with or without intraventricular haemorrhage (IVH) failed to show rupture of the terminal vein or germinal layer infarction. In babies of up to 28 weeks'' gestation GLH developed most frequently over the body of the caudate nucleus, whereas in babies of 29 weeks'' gestation or more the haemorrhages were usually over the head of the caudate nucleus. Histological study of 10 cases of GLH failed to show rupture either of arteries or veins, though evidence of rupture at a capillary-vein junction was seen in one case and masses of fibrin adjacent to the vein wall in 2 others. Injection through the carotid artery caused prominent leaks of injection mass within the germinal layer capillary bed, often adjacent to the veins. Injection through the jugular veins in 2 cases failed to rupture the terminal vein but caused multiple vein ruptures at the junction of deep and cortical venous systems. Additional small ruptures in the germinal layer occurred in one of the cases only. It is suggested that the capillaries within the germinal layer may be ruptured by a rise in arterial pressure, particularly in conditions of hypercapnia and hypoxia.     

Changing cognitive outcome in preterm infants with hyaline membrane disease

One hundred seventy-four preterm survivors of hyaline membrane disease, born 1961 through 1971, were followed up for at least six years with serial psychological and neurological evaluations. This relatively mature population had a mean birth weight of 2,133 g and gestational age of 34.6 weeks. All children had consecutive preschool and school age psychological tests. The mean preschool test score was 91 (SD = 13) and the mean school age score was 101 (SD = 16). The ten-point difference between the mean preschool and school age test scores was significant. Perinatal variables and indexes of disease severity did not correlate with test scores. Higher test scores were correlated with higher paternal educational and employment levels. Improving test scores by school age may be due to test instruments that measure different cognitive skills and/or the diminishing effects of prematurity.     

Cerebellar haemorrhage in the extremely preterm infant

Aim: The aim of this study was to investigate the incidence, risk factors and developmental outcomes of cerebellar haemorrhage in the extremely preterm infant. Methods: Over a 4‐year period from January 2004, all patients with cerebellar haemorrhage born at 24–27 weeks gestation or with a birthweight < 1000 g were identified from database review. All patients had cranial ultrasound scans including views from the mastoid fontanelle. To verify the incidence, a review of all reports over the 4‐year period and a review of all cranial imaging over a 2‐year period were carried out. Results: From the data analysed on 339 neonates, five cases of cerebellar haemorrhage were identified, four on ultrasound scan (1.2%) and one on magnetic resonance imaging (1.5% total). Two cases were associated with grade III peri‐intraventricular haemorrhage. The cases had diverse maternal, antenatal and post‐natal risk factors. The two with associated peri‐intraventricular haemorrhage have developmental delay. The cases with isolated cerebellar haemorrhage had good neurodevelopmental outcomes. Conclusions: A low incidence of cerebellar haemorrhage identified from the mastoid fontanelle was demonstrated. The neurodevelopmental outcome was better than that described in previous reports.     

早产儿肺透明膜病并发张力性气胸的治疗

目的 探讨早产儿肺透明膜病合并张力性气胸的救治措施.方法 回顾性分析2007年1月到2008年2月收治的21例早产儿肺透明膜病并发张力性气胸的临床资料.结果 21例患儿张力性气胸均治愈,其中8例出现皮下气肿.结论 首先进行静脉套管针简易胸腔闭式引流,然后采用小导管胸腔闭式引流治疗早产儿张力性气胸可取得明显治疗效果.     

Origin of intraventricular haemorrhage in the preterm infant

A technique has been developed for the injection and stereomicroscopic examination of blood vessels in the preterm newborn brain. Using this technique it can be seen that in the immature brain there is a rich capillary bed in the germinal layer region supplied mainly by Heubner's artery. Capillary channels drain directly into the terminal vein and its main branches. Study of 19 cases with spontaneous germinal layer haemorrhage (GLH) with or without intraventricular haemorrhage (IVH) failed to show rupture of the terminal vein or germinal layer infarction. In babies of up to 28 weeks' gestation GLH developed most frequently over the body of the caudate nucleus, whereas in babies of 29 weeks' gestation or more the haemorrhages were usually over the head of the caudate nucleus. Histological study of 10 cases of GLH failed to show rupture either of arteries or veins, though evidence of rupture at a capillary-vein junction was seen in one case and masses of fibrin adjacent to the vein wall in 2 others. Injection through the carotid artery caused prominent leaks of injection mass within the germinal layer capillary bed, often adjacent to the veins. Injection through the jugular veins in 2 cases failed to rupture the terminal vein but caused multiple vein ruptures at the junction of deep and cortical venous systems. Additional small ruptures in the germinal layer occurred in one of the cases only. It is suggested that the capillaries within the germinal layer may be ruptured by a rise in arterial pressure, particularly in conditions of hypercapnia and hypoxia.     

早产儿肺透明膜病的发病因素分析

肺透明膜病(HMI)是早产儿生后早期出现的严重并发症,也是造成早产儿死亡的常见原因之一.尽管对该病的研究不断深入,但就其发病情况目前国内尚缺乏确切的统计资料.本文对145例早产儿进行了回顾性分析,总结不同孕周HMD的发病情况及HMD发生的高危因素.     

Cardiovascular response to dopamine in hypotensive preterm neonates with severe hyaline membrane disease

The effect of low dose (2, 4, and 8 g/kg per min) dopamine infusion on blood pressure, heart rate and renal function was studied in 18 hypotensive, preterm infants with severe hyaline membrane disease (HMD). Significant dose-related effects found during dopamine infusion were systolic and diastolic blood pressure elevation and diuretic effect, while heart rate increase occurred only with 8 g/kg per min of the drug. This indicates, that in the preterm neonate, dopamine at low doses has a pronounced effect on the alpha-and dopamine-receptors, while its beta-receptor stimulating activity is minimal. We demonstrated a significantly decreased metabolic clearance rate of dopamine in preterm infants. Thus, beside the differences in the vascular receptors' maturation, the decreased metabolic clearance rate should also be taken into account when explaining the cardiovascular and renal effects of low dose dopamine infusion in these babies. Dopamine was found to be useful in normalizing low arterial blood pressure, in improving impaired peripheral circulation, and in producing a marked diuresis in hypotensive preterm neonates with severe hyaline membrane disease.Abbreviations CVP central venous pressure - HMD hyaline membrane disease - tcpO₂ transcutaneous oxygen tension - TPVR total peripheral vascular resistance     

双管鼻塞式CPAP在早产儿肺透明膜病和新生儿呼吸衰竭中应用

目的探讨双管鼻塞式CPAP对早产儿肺透明膜病(HMD)和新生儿呼吸衰竭的治疗价值。方法对NICU住院的11例HMD和19例不同原因引起的的新生儿呼吸衰竭患儿使用双管鼻塞式CPAP进行治疗,观察治疗前后临床症状、血气指标和胸片改善情况。结果30例患儿除2例治疗无效改用气管插管机械通气外,余28例治疗前后临床症状和血气指标均有明显改善。11例HMD患儿经CPAP治疗后,除1例27周超早产儿无改善外,余10例治疗前后胸片透亮度有明显增加,治疗前后血气指标PaCO2改善较快。结论带空氧混合器和湿化的双管鼻塞式小儿CPAP系列持续正压通气系统对HMD和新生儿呼吸衰竭具有明显的治疗效果,在用氧安全和减少CO2潴留方面具优越性。     

Resuscitation of preterm babies at birth reduces the risk of death from hyaline membrane disease

Increased attention to pulmonary aeration and oxygenation by early recourse to active resuscitation at birth was associated with a 20% reduction in mortality from hyaline membrane disease in preterm babies of 1-2 kg in 1971-76 compared with 1960-67. There were no other identifiable changes in management during this period.