Association Of Hemorrhage Research Articles

Exchange transfusion and hypernatremia: Possible role in intracranial hemorrhage in very-low-birth-weight infants

The association between neonatal intracranial hemorrhage and hypernatremia has been reported. 1 Transient hypernatremia has been noted in newborn infants following exchange transfusionY An increased incidence of intracran]al hemorrhage in association with exchange transfusion, however, has not been reported. The present communication suggests a relationship of intracranial hemorrhage, exchange transfusion, and hypernatremia. MATERIAL AND METHODS Thirty-two infants included in this retrospective study represented all.of the neonatal deaths over a 2~A-year period in our hospital.All were infants who survived eight or more hours, who had at least one serum sodium determination recorded, and on whom an autopsy was performed. Hypernatremia was defined as a sodium concentration of 150 mEq per liter or more. Exchange transfusion was performed with either packed ACD or CPD blood, less than five days old, reconstituted with freshly thawed plasma. Sodium bicarbonate was neither infused during the exchahge nor added to the donor blood. RESULTS The study population was divided into three groups: Group I, seven infants, had no intracranial hemorrhage; Group II, 19 infants, had germinal plate, subependymal, or intraventricular hemorrhage; and Group III, six infants, had subarachnoid, subdural, or cortical hemorrhage. The mean Apgar scores at five minutes for all groups were similar. The proportion of very low birth weight (VLBW) infants (< 1,501 gm) was similar in Groups II and III, but significantly less in Group I (P < 0.025). All infants in Groups II and III required mechanical ventilation �9 for respiratory distress, except �9 for two infants in Group II. The frequencies of exchange transfusion in the three groups were significantly different (P < 0.025), since 11 of the 12 trans'fused infants were from Group II. Hypernatremia was documented in. 14 infants: 13 in Group II, one in Group I, and n0ne:'in Group III. These differences were highly significant (P < 0.005). The incidence of hypernatremia in the VLBW infants in contrast with that in larger infants was significantly greater (P < 0.05) (Table 1). Ten of the 13 VLBW infants in Group II had exchange transfusions. Six of these ten infants were normonatremic and four Werehypernatremic prior to exchange transfusion. Nine of the infants either remained hypernatremic or became hypernatremic after exchange transfusion. Only one of the five VLBW infants in Group II! had an exchange transfusion and that infant remained normonatremic.

A Controlled Trial of Hydrocortisone Therapy in Infants With Respiratory Distress Syndrome: II. Pathology

The pathological findings from seven infants who died with respiratory distress syndrome and had been treated with placebo are compared with seven infants with comparable disease treated with hydrocortisone. Differences in lung, liver, adrenal, thymus, heart and spleen pathology attributable to steroid treatment did not occur between the two groups. A statistically significant association was found between intraventricular hemorrhage and steroid treatment. The pathological findings are consistent with the clinical results in that no beneficial effect occurs when steroids are used after an infant manifests respiratory distress. The possibility that elevated steroid levels increase the likelihood of intraventricular hemorrhage in association with respiratory distress syndrome is raised by these observations, although further information is needed to establish such a relationship.

Avulsed retinal vessels with retinal breaks; a cause of recurrent vitrous hemorrhage.

Data on 14 patients who had vitreous hemorrhage in association with a round retinal break and an avulsed, intact retinal vessel attached to the overlying operculum indicate that this association is a specific clinical entity for which a predictable course of events can be anticipated. Intermittent vitreous hemorrhages recur as long as the vessel remains intact over the operculum. Generally, the interval between hemorrhages is a few months, although recurrences may continue over several years. Hemorrhages no longer occur after the vessel becomes interrupted. This interruption is almost always associated with a final episode of bleeding. Various forms of treatment have not prevented recurrences of bleeding.

Spontaneous subarachnoid hemorrhage in pregnancy not complicated by toxemia

Ten cases of subarachnoid hemorrhage in association with pregnancy have been analyzed and the literature reviewed in an attempt to determine whether or not future pregnancies should be interdicted, whether or not present pregnancies should be interrupted, and the method of delivery to be used if they are allowed to continue. While there is no uniformity in the literature, these 10 cases were handled fairly uniformly, and certain principles emerge from the analysis. Avoidance of future pregnancies and interruption of early pregnancies, except in cases successfully treated surgically, seem justifiable. After the first trimester the pregnancy may be allowed to continue, but should be delivered electively as soon after 36 weeks as feasible, and by cesarean section, unless successful surgical treatment of the lesion has been carried out.

Haemorrhage in association with dextran infusion.

Haemorrhage in association with dextran infusion.

ANOMALY OF THE PERIPHERAL VESSELS IN A NEWBORN INFANT

The present paper reports a microscopic anomaly in the peripheral vascular system of an infant in conjunction with a death anatomically attributed to multiple small focal hemorrhages in association with formation of abscesses. A review of the literature fails to reveal any report of lesions resembling those about to be described. REPORT OF A CASE A two week old white boy was admitted to the children's division of the hospital on June 26, 1944 because of vomiting of one week's duration. The infant, born at full term, had been delivered by forceps and at birth weighed 6 pounds, 13 ounces (3,090 Gm.). He was a first child. The parents were living and well, and no history of familial disease was elicited. Physical Examination.—Physical examination revealed a poorly nourished infant weighing 5 pounds 14 ounces (2,665 Gm.) and appearing neither acutely ill nor dehydrated. A peanut-sized tumor mass was