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Correspondence: “Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage”

Journal of Perinatology volume 39, page 516 (2019)Cite this article

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The study “Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage” [1] attempts to address a very pertinent aspect of preventing intraventricular hemorrhage in extremely premature babies. There are certain queries related to this study:

  1. 1.

    Periventricular hemorrhagic infarction (PVHI) is postulated to occur due to the compression of the terminal vein, which makes a U-turn and passes through the germinal matrix. Hence, the most important trigger for PVHI is germinal matrix hemorrhage (GMH) [2]. In this study, the incidence of GMH, Grade II and Grade III haemorrhages are lower in the babies nursed in the FLAT group (nursed without head-end elevation) compared to the ELEV group (nursed with 30° head-end elevation), though statistically non-significant. Is there any other biologically plausible reason as to why the incidence of PVHI on the contrary is higher in the FLAT group compared to the ELEV group?

  2. 2.

    Did the authors look for cerebellar-parenchymal haemorrhages, which is a type of Grade IV intraventricular hemorrhage? It is important as the most recent met-analysis shows that cerebellar haemorrhages are associated with a very poor long-term neurodevelopmental outcome [3].

Periventricular hemorrhagic infarction (PVHI) is postulated to occur due to the compression of the terminal vein, which makes a U-turn and passes through the germinal matrix. Hence, the most important trigger for PVHI is germinal matrix hemorrhage (GMH) [2]. In this study, the incidence of GMH, Grade II and Grade III haemorrhages are lower in the babies nursed in the FLAT group (nursed without head-end elevation) compared to the ELEV group (nursed with 30° head-end elevation), though statistically non-significant. Is there any other biologically plausible reason as to why the incidence of PVHI on the contrary is higher in the FLAT group compared to the ELEV group?

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References

  1. Kochan M, Leonardi B, Firestine A, McPadden J, Cobb D, Shah TA, et al. Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage. J Perinatol. 2018;39:54–62.

  2. Bassan H. Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol. 2009;36:737–62.

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  3. Hortensius LM, Dijkshoorn ABC, Ecury-Goossen GM, Steggerda SJ, Hoebeek FE, Benders MJNL, et al. Neurodevelopmental consequences of preterm isolated cerebellar hemorrhage: a systematic review. Pediatrics. 2018;142:1–11.

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  1. Nori Multi-speciality Hospital Vijayawada, Andhra Pradesh, India

    V R Viraraghavan

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  1. V R Viraraghavan
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Correspondence to V R Viraraghavan.

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Viraraghavan, V.R. Correspondence: “Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage”. J Perinatol 39, 516 (2019). https://doi.org/10.1038/s41372-018-0301-x

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