Intracranial dynamics in pre-term infants and neonates: implications for physiotherapists

The control of cerebral circulation and intracranial dynamics differs markedly in the pre-term and full term neonate from that in the adult. Immaturity can combine with several clinical conditions and iatrogenic factors to predispose the neonate to cerebral lesions, which may subsequently increase morbidity. As physiotherapists play an increasingly important role in neonatology, it is important to appreciate the immaturity of the nervous system and to recognise the risk factors for such conditions as peri-intraventricular haemorrhage and periventricular leucomalacia. This paper describes intracranial dynamics in the pre-term and full term infant and illustrates how these factors may interact with clinical conditions to cause cerebral lesions. Studies which examine the effect of respiratory physiotherapy on intracranial dynamics are reviewed and suggestions made for further research.