INTRAVENTRICULAR HEMORRHAGE IN THE PRETERM NEONATE - TIMING AND CEREBRAL BLOOD-FLOW CHANGES
INTRAVENTRICULAR HEMORRHAGE IN THE PRETERM NEONATE - TIMING AND CEREBRAL BLOOD-FLOW CHANGES
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DOI：
10.1016/s0022-3476(84)81109-9
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发表时间：
1984-01-01
影响因子：
5.1
通讯作者：
GETTNER, P
中科院分区：
文献类型：
--
作者：
MENT, LR;DUNCAN, CC;GETTNER, P
连续颅超声研究。对31例早产儿进行133X吸入性脑血流量测定及危险因素分析。另外对这31名婴儿中的16名进行了超声心动图对比研究。61%有生发基质[GMH]或脑室内出血[IVH]。在所有出血中，74%在产后30小时被发现。将患者分为3组：出生后第6小时早期GMH/IVH组（8例），6小时至5天GMH/IVH组（10例），无GMH/IVH组（12例）。早期GMH/IVH组产后6 h脑血流量显著低于未GMH/IVH组（P < 0.01）。仅在早期出血的婴儿中观察到GMH/IVH的进展，这些婴儿的新生儿死亡率明显更高。超声检查发现，脑室肿大在有和没有GMH/IVH的婴儿中同样明显（50%），并且与低脑血流量无关。早期出血患者在出生时需要更有力的复苏，并且在出生后的前36小时内呼吸机设置明显更高，在此期间他们也有更高的PCO2 [CO2分压]值。所有组的动脉导管未闭发生率相等。早期GMH/IVH可能与围产期事件有关，早期GMH/IVH婴儿脑血流量显著减少可能继发于出血本身。早期GMH/IVH的进展和新期GMH/IVH可能与已知改变脑血流的晚期新生儿事件有关。
Serial cranial ultrasound studies. 133X inhalation cerebral blood flow determinations, and risk factor analyses were performed in 31 preterm neonates. Contrast echocardiographic studies were additionally performed in 16 of these 31 infants. Sixty-one percent had germinal matrix [GMH] or intraventricular hemorrhage [IVH]. Of all hemorrhages, 74% were detected by the 30 postnatal hour. The patients were divided into 3 groups: early GMH/IVH by the 6th postnatal hour (8 infants) interval GMH/IVH from 6 h through 5 days (10), and no GMH/IVH (12). Cerebral blood flow values at 6 postnatal hours were significantly lower for the early GMH/IVH group than for the no GMH/IVH group (P < 0.01). Progression of GMH/IVH was observed only in those infants with early hemorrhage, and these infants had a significantly higher incidence of neonatal mortality. Ventriculomegaly as determined by ultrasound studies was noted equally in infants with and without GMH/IVH (50%) and did not correlate with low cerebral blood flow. The patients with early hemorrhage were distinguishable by their need for more vigorous resuscitation at the time of birth and significantly higher ventilator setting during the 1st 36 postnatal hours, during which time they also had higher values of PCO2 [partial pressure of CO2]. An equal incidence of patent ductus arteriosus was found across all of the groups. Early GMH/IVH may be related to perinatal events and the significant decrease in cerebral blood flow found in infants with early GMH/IVH is probably secondary to the presence of the hemorrhage itself. Progression of early GMH/IVH and new interval GMH/IVH may be related to later neonatal events known to alter cerebral blood flow.