Rochelle Burstein

In a prospective study, 100 premature infants were studied with computed tomography (CT) brain scans within the first week of life. In 44 of these,hemorrhages originated from the subependymal germinal matrix, and ranged in severity from isolated germinal matrix hemorrhages to blood-filled, dilated ventricles with extension of hemorrhage into the brain parenchyma. A system of grading the severity of hemorrhage was developed. Grades I and II hemorrhages resolved spontaneously and grades III and IV were associated with progressive hydrocephalus. Asymptomatic hemorrhages that would not have been diagnosed on clinical grounds were detected by CT. This study offers a clearer understanding of the true incidence and natural history of cerebroventricular hemorrhage and associated hydrocephalus in premature neonates and may clarify etiologic factors and identify children at risk for subsequent neurologic abnormalities.

Nine infants with bronchopulmonary dysplasia underwent cardiac catheterization to define thier circulatory status. In room air, the mean cardiac index was normal (3.4 liters/min/sq m), but pulmonary arterial pressure (39 mm Hg, mean) and pulmonary vascular resistance (8.6 Wood units . sq m) were elevated. Preejection period/right ventricular ejection time ratios determined echocardiographically correlated well with values obtained at catheterization, but did not correlate well with hemodynamic values. Administration of 40% and 88% oxygen caused variable responses in hemodynamic measurements. Studies of left ventricular function were normal in all patients. These findings raise questions about the long-term prognosis of infants with bronchopulmonary dysplasia.