Skip to main content
SpringerLink
Log in

Hemorrhages in Asphyxiated Premature Infants

  • Chapter
Developmental Neuropathology

Abstract

Intracranial hemorrhages, in particular subependymal, intraventricular and leptomeningeal hemorrhages, are the most common autopsy findings in the brains of asphyxiated premature infants. Clinical studies using ultrasonography or CT show an incidence of germinal layer/intraventricular hemorrhage as high as 43 and 46% in infants below 1500 g birth weight (Hawgood et al. 1984); however, there are considerable differences between frequencies reported from various institutions. Leech et al. (1979) recorded the following bleeding sites in 170 infants: subependymal 60%; intraventricular 68%; intracerebral and intracerebellar 9%; subarachnoid 44%; intradural 48%; subdural 3%; choroid plexus 4%; and cerebral petechiae 3%. Reviews are the monography by Pape and Wigglesworth (1979) and by Tarby and Volpe (1982) and Goddard-Finegold (1984).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Ahmann PA, Dykes FD, Lazzara A, Holt PJ, Giddens DP, Carrigan TA (1983) Relationship between pressure passivity and subependymal/intraventricular hemorrhage as assessed by pulsed Doppler ultrasound. Pediatrics 72:665–669

    PubMed  CAS  Google Scholar 

  • Allan WC, Volpe JJ (1986) Periventricular-intraventriuclar hemorrhage. Pediatr Clin North Am 36:47–63

    CAS  Google Scholar 

  • Allan WC, Holt PJ, Sawyer LR, Tito AM, Meade SK (1982) Ventricular dilation after neonatal periventricular-intraventricular hemorrhage. Natural history and therapeutic implications. Am J Dis Child 136:589–593

    PubMed  CAS  Google Scholar 

  • Allan WC, Dransfield DA, Tito AM (1984) Ventricular dilation following periventricular-intraventricular hemorrhage. Outcome at age 1 year. Pediatrics 73:158–162

    CAS  Google Scholar 

  • Armstrong D, Norman MG (1974) Periventricular leucomalacia in neonates. Complications and sequelae. Arch Dis Child 49:367–375

    Article  PubMed  CAS  Google Scholar 

  • Barmada MA, Moossy J (1980) The developmental factor in neonatal cerebral vascular lesions. J Neuropathol Exp Neurol 39:340 (abstract 10)

    Google Scholar 

  • Bergman I, Bauer RE, Barmada MA, Latchaw RE, Taylor HG, David R, Painter MJ (1985) Intracerebral hemorrhage in the full-term neonatal infant. Pediatrics 75:488–496

    PubMed  CAS  Google Scholar 

  • Camfield PR, Camfield CS, Allen AC, Rees EP, Stinson DA, Urban LE (1981) Progressive hydrocephalus in infants with birth weights less than 1,500 g. Arch Neurol 38:653–655

    PubMed  CAS  Google Scholar 

  • Claireaux AE (1959) Cerebral pathology in the newborn. Guys Hosp Rep 108:2–20

    PubMed  CAS  Google Scholar 

  • Conner ES, Lorenzo AV, Welch K, Dorval B (1983) The role of intracranial hypotension in neonatal intraventricular hemorrhage. J Neurosurg 58:204–209

    Article  PubMed  CAS  Google Scholar 

  • Coulter DM, LaPine T, Gooch III WM (1984) Intraventricular hemorrhage in the premature rabbit pup. Limitations of this animal model. J Neurosurg 60:1243–1245

    Article  PubMed  CAS  Google Scholar 

  • Courten GM de, Rabinowicz T(1981) Intraventricular hemorrhage in premature infants: reappraisal and new hypothesis. Dev Med Child Neurol 23:389–403

    PubMed  Google Scholar 

  • Courville CB (1971) Birth and brain damage. MF Courville, Pasadena, Cal, 1971

    Google Scholar 

  • Couvelaire A (1903) Hémorragies du système nerveux central des nouveau-nés dans leurs rapports avec la naissance prématurée et l’accouchement laborieux. Ann Gynécol Obstet (Paris) 59:253–268

    Google Scholar 

  • Craig WS (1938) Intracranial haemorrhage in the newborn. A study of diagnosis and differential diagnosis based upon pathological and clinical findings in 126 cases. Arch Dis Child 13:89–124

    Article  PubMed  CAS  Google Scholar 

  • Donat JF, Okazaki H, Kleinberg F (1979) Cerebellar hemorrhages in newborn infants. Am J Dis Child 133:441

    PubMed  CAS  Google Scholar 

  • Dyer N, Brill AB, Gutberlat R, Raye J, Faxelius G, Swanstrom S, Stahlman M (1971) Timing of intracranial bleeding in newborn infants. J Nuclear Med 12:353–354 (abstr)

    Google Scholar 

  • Dykes FD, Lazzara A, Ahmann P, Blumenstein B, Schwartz J, Brann AW (1980) Intraventricular hemorrhage: a prospective evaluation of etiopathogenesis. Pediatrics 66:42–49

    PubMed  CAS  Google Scholar 

  • Eller TW, Pasternak JF(1985) Isolated ventricles following intraventricular hemorrhage. J Neurosurg 62:357–362

    Article  PubMed  CAS  Google Scholar 

  • Emerson P, Fujimura M, Howat P, Howes D, Keeling J, Robinson RO, Salisbury D,Tizard JPM (1977) Timing of intraventricular haemorrhage. Arch Dis Child 52:183–187

    Article  PubMed  CAS  Google Scholar 

  • Fedrick J (1971) Neonatal deaths. Time of death, maturity and lesion. Biol Neonate 18:369–378

    Article  PubMed  CAS  Google Scholar 

  • Fedrick J, Butler NR (1970) Certain causes of neonatal death. II. Intraventricular haemorrhage. Biol Neonate 15:257–290

    Article  PubMed  CAS  Google Scholar 

  • Fenichel GM, Webster DL, Wong WKT(1984) Intracranial hemorrhage in the term newborn. Arch Neurol 41:30–34

    PubMed  CAS  Google Scholar 

  • Friede RL (1972) Subpial hemorrhage in infants. J Neuropathol Exp Neurol 31:548–556

    Article  PubMed  CAS  Google Scholar 

  • Fujimura M, Salisbury DM, Robinson RO, Howat P, Emerson PM, Keeling JW, Tizard JPM (1979). Clinical events relating to intraventricular haemorrhage in the newborn. Arch Dis Child 54:409–414

    Article  PubMed  CAS  Google Scholar 

  • Gilles FH, Price RA, Kevy SV, Berenberg W(1971) Fibrinolytic activity in the ganglionic eminence of the premature human brain. Biol Neonate 18:426–432

    Article  PubMed  CAS  Google Scholar 

  • Glaser J (1928) The cerebrospinal fluid of premature infants. With special reference to intracranial hemorrhage and pigmentation. Am J Dis Child 36:195–247

    Google Scholar 

  • Goddard J, Lewis RM, Alcala H, Zeller RS (1980) Intraventricular hemorrhage. An animal model. Biol Neonate 37:39–52

    Article  PubMed  CAS  Google Scholar 

  • Goddard-Finegold J (1984) Periventricular, intraventricular hemorrhages in the premature newborn. Update on pathologic features, pathogenesis, and possible means of prevention. Arch Neurol 41:766–771

    PubMed  CAS  Google Scholar 

  • Goddard-Finegold J, Michael LH (1984) Cerebral blood flow and experimental intraventricular hemorrhage. Pediatr Res 18:7–11

    PubMed  CAS  Google Scholar 

  • Gröntoft O (1953a) Intracerebral and meningeal haemorrhages in perinatally deceased infants. I. Intracerebral haemorrhages. A pathologico-anatomical and obstetric study. Acta Obstet Gynecol Scand 32:308–334

    Article  PubMed  Google Scholar 

  • Gröntoft O (1953b) Intracerebral and meningeal haemorrhages in perinatally deceased infants. II. Meningeal haemorrhages. A pathologico-anatomical and obstetric study. Acta Obstet Gynecol Scand 32:458–498

    Article  PubMed  Google Scholar 

  • Gruenwald P (1951) Subependymal cerebral hemorrhage in premature infants, and its relation to various injurious influences at birth. Am J Obstet Gynecol 61:1285–1292

    PubMed  CAS  Google Scholar 

  • Hambleton G, Wigglesworth JS (1976) Origin of intraventricular haemorrhage in the preterm infant. Arch Dis Child 51:651–659

    Article  PubMed  CAS  Google Scholar 

  • Harris LS, Roessmann U, Friede RL (1968) Bursting of cerebral ventricular walls. J Pathol Bacteriol 96:33–38

    Article  PubMed  CAS  Google Scholar 

  • Hausbrandt F, Meier A (1936) Zur Kenntnis der geburtstraumatischen und extrauterin erworbenen Schäden des Zentralnervensystems bei Neugeborenen. Frankfurt Z Pathol 49:21–62

    Google Scholar 

  • Hawgood S, Spong J, Yu VYH (1984) Intraventricular hemorrhage. Am J Dis Child 138:136–139

    PubMed  CAS  Google Scholar 

  • Hayden CK Jr, Shattuck KE, Richardson CJ, Ahrendt DK, House R, Swischuk LE (1985) Subependymal germinal matrix hemorrhage in full-term neonates. Pediatrics 75:714–718

    PubMed  Google Scholar 

  • Hegedüs K, Molnar P (1985) Histopathological study of major intracranial arteries in premature infants related to intracranial hemorrhage. J Neurosurg 62:419–424

    Article  PubMed  Google Scholar 

  • Hemsath FA, Canavan MM (1932) Microscopic cerebral hemorrhage in stillbirths and newborn deaths. A study of fifty-three infants with relation to minute hemorrhages of the medulla oblongata. Am J Obstet Gynecol 23:471–478

    Google Scholar 

  • Hill A (1983) Ventricular dilation following intraventricular hemorrhage in the premature infant. Can J Neurol Sci 10:81–85

    PubMed  CAS  Google Scholar 

  • Hill A, Rozdilsky B (1984) Congenital hydrocephalus secondary to intra-uterine germinal matrix/ intraventricular haemorrhage. Dev Med Child Neurol 26:524–527

    Article  PubMed  CAS  Google Scholar 

  • Hill A, Volpe JJ (1981) Normal pressure hydrocephalus in the newborn. Pediatrics 68:623–629

    PubMed  CAS  Google Scholar 

  • Hill A, Melson GL, Clark HB, Volpe JJ (1982) Hemorrhagic periventricular leukomalacia: diagnosis by real time ultrasound and correlation with autopsy findings. Pediatrics 69:281–284

    Google Scholar 

  • Hirvensalo M (1949) On hemorrhages of the medulla oblongata and the pons and on respiratory disorders in premature infants. Acta Paediatr 37, Suppl 73:1–120

    Google Scholar 

  • Jackson JC, Blumhagen JD (1983) Congenital hydrocephalus due to prenatal intracranial hemorrhage. Pediatrics 72:344–346

    PubMed  CAS  Google Scholar 

  • Kleihauer E (1973) Feststellung des Zeitpunktes von intrakraniellen Blutungen bei Neugeborenen. 5. Deutscher Kongreß für Perinatale Medizin, Berlin 1972. Perinatale Med 4:429–433

    Google Scholar 

  • Lacey DJ, Terplan K (1982) Intraventricular hemorrhage in full-term neonates. Dev Med Child Neurol 24:332–337

    Article  PubMed  CAS  Google Scholar 

  • Larroche J-C (1964) Hémorragies cérébrales intra-ventriculaires chez le prémature. Ie partie: Anatomie et Physiopathologie. Biol Neonat 7:26–56

    Article  PubMed  CAS  Google Scholar 

  • Larroche J-C (1972 a) Post-haemorrhagic hydrocephalus in infancy. Anatomical study. Biol Neonate 20:287–299

    Article  CAS  Google Scholar 

  • Larroche J-C (1972b) Sub-ependymal pseudo-cysts in the newborn. Biol Neonate 21:170–183

    Article  PubMed  CAS  Google Scholar 

  • Leech RW, Kohnen P (1974) Subependymal and intraventricular hemorrhages in the newborn. Am J Pathol 77:465–476

    PubMed  CAS  Google Scholar 

  • Leech RW, Olson MI, Alvord EC Jr (1979) Neuropathologic features of idiopathic respiratory distress syndrome. Arch Pathol Lab Med 103:341–343

    PubMed  CAS  Google Scholar 

  • Levene MI, Starte DR (1981) A longitudinal study of post-haemorrhagic ventricular dilatation in the newborn. Arch Dis Child 56:905–910

    Article  PubMed  CAS  Google Scholar 

  • Levene MI, Wigglesworth JS, Dubowitz V (1981) Cerebral structure and intraventricular haemorrhage in the neonate: a real-time ultrasound study. Arch Dis Child 56:416–424

    Article  PubMed  CAS  Google Scholar 

  • Lorenzo AV, Welch K, Conner S (1982) Spontaneous germinal matrix and intraventricular hemorrhage in prematurely born rabbits. J Neurosurg 56:404–410

    Article  PubMed  CAS  Google Scholar 

  • Lou HC (1980) Perinatal hypoxic-ischemic brain damage and intraventricular hemorrhage. A pathogenetic model. Arch Neurol 37:585–587

    PubMed  CAS  Google Scholar 

  • Lou HC, Lassen NA, Friis-Hansen B (1979) Impaired autoregulation of cerebral blood flow in the distressed newborn infant. J Pediatr 94:118–121

    Article  PubMed  CAS  Google Scholar 

  • Martin R, Roessmann U, Fanaroff A (1976) Massive intracerebellar hemorrhage in low-birth-weight infants. J Pediatr 89:290–292

    Article  PubMed  CAS  Google Scholar 

  • McMenamin JB, Shackelford GD, Volpe JJ (1984) Outcome of neonatal intraventricular hemorrhage with periventricular echodense lesions. Ann Neurol 15:285–290

    Article  PubMed  CAS  Google Scholar 

  • Ment LR, Ehrenkranz RA, Lange RC, Rothstein PT, Duncan CC (1981) Alterations in cerebral blood flow in preterm infants with intraventricular hemorrhage. Pediatrics 68:763–769

    PubMed  CAS  Google Scholar 

  • Ment LR, Stewart WB, Duncan CC, Lambrecht R (1982) Beagle puppy model of intraventricular hemorrhage. J Neurosurg 57:219–223

    Article  PubMed  CAS  Google Scholar 

  • Ment LR, Duncan CC, Scott DT, Ehrenkranz RA (1984a) Posthemorrhagic hydrocephalus. Low incidence in very low birth weight neonates with intraventricular hemorrhage. J Neurosurg 60:343–347

    Article  PubMed  CAS  Google Scholar 

  • Ment LR, Duncan CC, Ehrenkranz RA, Lange RC, Taylor KJ, Kleinman CS, Scott DT, Sivo J, Gettner P (1984b) Intraventricular hemorrhage in the preterm neonate: timing and cerebral blood flow changes. J Pediatr 104:419–425

    Article  PubMed  CAS  Google Scholar 

  • Moriette G, Relier J-P, Larroche J-C (1977) Les hémorragies intra-ventriculaires au cours de la maladie des membranes hyalines. Arch Fr Pediatr 34:492–504

    PubMed  CAS  Google Scholar 

  • Nanba E, Eda I, Takashima S, Ohta S, Ohtani K,Takeshita K (1984) Intracranial hemorrhage in the full-term neonate and young infant: correlation of the location and outcome. Brain Dev 6:435–443

    PubMed  CAS  Google Scholar 

  • Norman RM (1969) Malformations of the nervous system, birth injury and diseases of early life. In Greenfields Neuropathology, Chap. 6, 324–440. Arnold 1969

    Google Scholar 

  • Pape KE, Wigglesworth JS (1979) Hemorrhage, ischaemia and the perinatal brain. Heinemann Medical, London (Clinics in Developmental Medicine, vol 69/70)

    Google Scholar 

  • Pape KE, Armstrong DL, Fitzhardinge PM (1976) Central nervous system pathology associated with mask ventilation in the very low birthweight infant: a new etiology for intracerebellar hemorrhages. Pediatrics 58:473–483

    PubMed  CAS  Google Scholar 

  • Pasternak JF, Groothuis DR (1984) Regional variability of blood flow and glucose utilization within the subependymal germinal matrix. Brain Res 299:281–288

    Article  PubMed  CAS  Google Scholar 

  • Pasternak JF, Mantovani JF, Volpe JJ (1980) Porencephaly from periventricular intracerebral hemorrhage in a premature infant. Am J Dis Child 134:673–675

    PubMed  CAS  Google Scholar 

  • Perlman JM, Volpe JJ (1986) Intraventricular hemorrhage in extremely small premature infants. Am J Dis Child 140:1122–1124

    PubMed  CAS  Google Scholar 

  • Povlishock JT, Martinez AJ, Moossy J (1977) The fine structure of blood vessels of the telencephalic germinal matrix in the human fetus. Am J Anat 149:439–452

    Article  PubMed  CAS  Google Scholar 

  • Reynolds ML, Evans CAN, Reynolds EOR, Saunders NR, Durbin GM, Wigglesworth JS (1979) Intracranial haemorrhage in the preterm sheep fetus. Early Hum Dev 3:163–186

    Article  PubMed  CAS  Google Scholar 

  • Rorke LB (1982) Pathology of perinatal brain injury. Raven, New York

    Google Scholar 

  • Ross JJ, Dimmette RM (1965) Subependymal cerebral hemorrhage in infancy. Am J Dis Child 110:531–542

    PubMed  CAS  Google Scholar 

  • Ruckensteiner E, Zöllner F (1929) Über die Blutungen im Gebiete der Vena terminalis bei Neugeborenen. Frankfurt Z Pathol 37:568–578

    Google Scholar 

  • Rydberg E (1932) Cerebral injury in new-born children consequent on birth trauma; with an inquiry into the normal and pathological anatomy of the neuroglia. Dissertations medicae Lundenses 1930–1932. Acta Pathol Microbiol Scand, Suppl 10:1–247

    Google Scholar 

  • Scher MS, Wright FS, Lockman LA, Thompson TR (1982) Intraventricular hemorrhage in the full-term neonate. Arch Neurol 39:769–772

    PubMed  CAS  Google Scholar 

  • Schwartz P (1927) Die traumatischen Schädigungen des Zentralnervensystems durch die Geburt. Anatomische Studien. Ergeb Inn Med Kinderheilkd 31:165–372

    Google Scholar 

  • Schwartz P, Fink L (1926) Morphologie und Entstehung der geburtstraumatischen Blutungen in Gehirn und Schädel des Neugeborenen. Z Kinderheilkd 40:427–474

    Article  Google Scholar 

  • Shen E-Y, Huang F-Y (1985) Subependymal cysts in normal neonates. Arch Dis Child 60:1072–1074

    Article  PubMed  CAS  Google Scholar 

  • Sherwood A, Hopp A, Smith JF (1978) Cellular reactions to subependymal plate haemorrhage in the human neonate. Neuropathol Appl Neurobiol 4:245–261

    Article  PubMed  CAS  Google Scholar 

  • Shuman RM, Oliver TK Jr (1976) Face masks defended. Pediatrics 58:621–623

    PubMed  CAS  Google Scholar 

  • Siegmund H (1955) Die geburtstraumatischen Veränderungen des Zentralnervensystems einschließlich der Encephalitis congenita Virchow. Handbuch der Speziellen Pathologischen Anatomie und Histologie XIII/3:239–287

    Google Scholar 

  • Solcher H (1968) Zur Neuroanatomie und Neuropathologie der Frühfetalzeit. Springer, Berlin Heidelberg New York (Monographien aus dem Gesamtgebiete der Neurologie und Psychiatrie, Bd 127)

    Google Scholar 

  • Spears RL, Hodgman JE, Cleland R, Tatter D, Hanes B (1969) Relationship between hyaline membrane disease and intraventricular hemorrhage as cause of death in low birth weight infants. Am J Obstet Gynecol 105:1028–1031

    PubMed  CAS  Google Scholar 

  • Szymonowicz W, Yu VYH, Wilson FE (1984) Antecedents of periventricular haemorrhage in infants weighing 1250 g or less at birth. Arch Dis Child 59:13–17

    Article  PubMed  CAS  Google Scholar 

  • Takashima S, Tanaka K (1978) Microangiography and vascular permeability of the subependymal matrix in the premature infant. Can J Neurol Sci 5:45–50

    PubMed  CAS  Google Scholar 

  • Tarby TJ, Volpe JJ (1982) Intraventricular hemorrhage in the premature infant. Pediatr Clin North Am 29:1077–1104

    PubMed  CAS  Google Scholar 

  • Ting P, Yamaguchi S, Bacher JD, Killens RH, Myers RE (1984) Failure to produce germinal matrix or intraventricular hemorrhage by hypoxia, hypo-, or hypervolemia. Exp Neurol 83:449–460

    Article  PubMed  CAS  Google Scholar 

  • Towbin A (1968) Cerebral intraventricular hemorrhage and subependymal matrix infarction in the fetus and premature newborn. Am J Pathol 52:121–139

    PubMed  CAS  Google Scholar 

  • Tsiantos A, Victorin L, Relier JP, Dyer N, Sundell H, Brill AB, Stahlman M (1974) Intracranial hemorrhage in the prematurely born infants. Timing of clots and evaluation of clinical signs and symptoms. J Pediatr 85:854–859

    Article  PubMed  CAS  Google Scholar 

  • Volpe JJ, Pasternak JF, Allan WC (1977) Ventricular dilation preceding rapid head growth following neonatal intracranial hemorrhage. Am J Dis Child 131:1212–1215

    PubMed  CAS  Google Scholar 

  • Ylppö A (1919) Pathologisch-anatomische Studien bei Frühgeborenen. Z Kinderheilkd 20:212–431

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Zentrum Neurologische Medizin, Abteilung Neuropathologie, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 3400, Göttingen, Germany

    Reinhard L. Friede

Authors
  1. Reinhard L. Friede
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 1989 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Friede, R.L. (1989). Hemorrhages in Asphyxiated Premature Infants. In: Developmental Neuropathology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73697-1_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-73697-1_4

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-73699-5

  • Online ISBN: 978-3-642-73697-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation