Abstract
PVH is the most common cause of death of LBW infants, accounting for 45% of deaths of infants < 1500 gm admitted to our ICU in 1976. To delineate the signs of PVH, we have analyzed the clinical findings of infants who died in 1976 with suspected PVH. Mean birth weight ± SD = 1070 ± 273 gm; gestational age = 31 ± 2.7 wks. A clinical diagnosis of PVH was made at 1-15 days (mean = 3.1) and confirmed by autopsy in 13 (Group I). 13 had no autopsy, but had bloody CSF and severe neurologic signs (Group II). Significant changes in hematocrit, blood pressure, temperature, and blood glucose each occurred in 20-50% of infants. 12 (46%) required mechanical ventilation despite an Fi02 ≥ 0.3. 23 (88%; 11 Group I) had PMA with pH < 7.25 for > 8 hrs. despite oxygen and transfusion therapy; 7 (27%) had a pH < 7.20 > 8 hrs. NaHC03 was used sparingly and serum Na+ > 145 mEq/L occurred in only 1 infant. IADH was suspected in 12 (46%; 5 Group I), each having concentrated urine, weight gain, and serum Na < 130 mEq/L (mean = 119 mEq/L). Urine Na+ recorded in 7 was > 35 mEq/L. 11 (42%) had both IADH and PMA within 24 hrs. of other signs. IADH, rarely reported in neonates, appears to occur commonly with PMA as a sign of PVH. In view of an 88% incidence of PMA, a causal relationship of NaHC03 therapy to PVH can be established only if treatment precedes onset of signs.
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Furzan, J., Rosenfeld, C. & Tyson, J. 1128 INAPPROPRIATE ADH SYNDROME (IADH) AND PERSISTENT METABOLIC ACIDOSIS (PMA) IN NEONATAL PERIVENTRICULAR HEMORRHAGE (PVH). Pediatr Res 12 (Suppl 4), 552 (1978). https://doi.org/10.1203/00006450-197804001-01134
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DOI: https://doi.org/10.1203/00006450-197804001-01134