Intrathoracic pressure fluctuations and periventricular haemorrhage in the newborn.

The incidence of periventricular intraventricular haemorrhage (PVH-IVH) in premature infants with respiratory distress syndrome (RDS) remains at about 40%. Although there are certain inherent anatomical and physiological features of a neonate which predisposes them to PVH-IVH, there is conflicting evidence about the precipitating cause. The most significant antecedents of PVH-IVH are mechanical ventilation and barotrauma. This report examines the hypothesis that the final common pathway in PVH-IVH is fluctuation in intrathoracic pressure, and then attempts to explain previous anomalies and conflicting results which have implicated other causes. Suggestions are offered as to how changes in current management could contribute to a decreased incidence of this serious and widespread complication in premature infants with RDS.