[Asphyxia and intracranial hemorrhage in high-risk neonates of various gestational ages]

The aim of this study was to compare the type and severeness of brain damage in vitally most endangered newborn infants of different gestational age. We retrospectively analyzed the records of 75 newborn infants treated and decreased at the Department of Intensive Care and Therapy of the Institute of Children's and Adolescents' Health Care in Novi Sad. Diagnoses of hypoxic-ischemic lesion and intracranial hemorrhage in the case of grade four PVH-IVH (periventricular hemorrhage-intraventricular hemorrhage) were established by ultrasonography of the brain and lumbar punction in the case of subarachnoid hemorrhage. These diagnoses were confirmed after forensic-medical expertise. The volume and degree of the damage were compared in regard to the gestational age, Apgar score and time of initial mechanical ventilation and initial parameters of the mechanical ventilation, as well as to values of acido-basic status, concentration of gases in arterialized capillary blood and type of lung damage which always occurred in these patients. In all 75 examined newborns perinatal asphyxia was the dominant etiologic factor for the course and outcome of the disease (in all patients Apgar score was 4 or less). 75% of examines were born before 32 weeks gestation and of low or very low body weight, whereas 72% had intracranial hemorrhage (periventricular-intraventricular) and hypoxic-ischemic damage of the brain parenchyma. The rest of examinees had intracranial hemorrhage or hypoxic-ischemic damage of the brain parenchyma. Although 92% of examinees received mechanical ventilation in the first 3 days of life, only 20% of newborn infants had satisfactory values of acido-basic status and gas concentrations in the blood. We concluded that in the most severe cases of perinatal asphyxia, especially in preterm newborns of low or very low body weight, both intracranial hemorrhage and hypoxic-ischemic encephalopathy develop. Damages of other organs or systems of organs, especially lungs, as a rule contribute to infaust ending.