Low-grade intraventricular hemorrhage: is ultrasound good enough?

OBJECTIVE: To assess diagnostic accuracy of cranial ultrasonography (CUS) in detecting low-grade (i.e. grade I and grade II) germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) in very low birth weight (VLBW) infants. METHODS: Among VLBW infants who were admitted to Gaslini Children's Hospital neonatal intensive care unit between January and November 2012, patients who underwent both serial CUS since birth and magnetic resonance susceptibility-weighted imaging (SWI) at term-equivalent age were included in this retrospective study. Diagnostic accuracy of CUS in detecting low-grade GMH-IVH was assessed in terms of sensitivity and specificity by comparing it to SWI, which was used as the gold-standard technique. RESULTS: Sixty VLBW infants were included in the study. Sensitivity of CUS in detecting low-grade GMH-IVH was low (60%), whilst specificity was 100%. CONCLUSIONS: In the present study, CUS sensitivity in detecting grade I-II GMH-IVH proved to be surprisingly low, in contrast with specificity. In other words, we suggest that low-grade GMH-IVH may be underdiagnosed in VLBW infants when assessed exclusively with CUS.

Different gestational ages and changing vulnerability of the premature brain.

In recent decades, there has been a general increase in survival rates of preterm and low birth weight infants, but this overall decrease in perinatal mortality has not been accompanied by a decrease in long-term physical and mental disability. In order to reduce the long-term sequelae of prematurity and to establish preventive measures, it is important to identify risk factors since the main determinant of specific vulnerability to different types of lesions is gestational age. The regional tissue vulnerability at a given gestational age is probably determined by the local metabolic requirements together with specific cell characteristics and their level of maturation. In this article, we discuss the most common neonatal cerebral lesions (cerebellar haemorrhage, germinal matrix intraventricular haemorrhage, periventricular leukomalacia, arterial ischaemic stroke, cerebral vein sinus thrombosis and hypoxic-ischaemic encephalopathy) related to the gestational age-dependent vulnerability of the premature brain.

Early surfactant for respiratory distress syndrome in premature infants.

Effects of early surfactant administration to premature newborns have been widely investigated in several RCTs. Furthermore, recent studies and metanalysis have compared early with delayed administration as well as selective and prophylactic use of surfactant. These data from the literature are discussed in the present review together with the factors that may argue against the standardization of respiratory care at birth. A tailored approach based on the stratification of risk factors may be appropriate in the so heterogeneous population of premature newborns.