Intracranial haemorrhage associated with hyaline membrane disease.

Intracranial haemorrhage is commonly found at necropsy in association with hyaline membrane disease. The bleeding usually occurs in the subarachnoid or intraventricular sites (Hutchison, Kerr, Douglas, Inall, and Crosbie, 1964), but its cause is as yet poorly established. Cerebral haemorrhage unrelated to hyaline membrane disease frequently occurs in premature infants (Craig, 1938), and anoxia is thought to be an important factor in its pathogenesis. The same sites are involved, but occasionally bleeding may present in the subdural space if blood under tension ruptures through the fine leptomeninges (Claireaux, 1964). By contrast, traumatic bleeding from a torn falx cerebri or tentorium is subdural in origin and is most prevalent in full-term infants (Craig, 1938). The incidence of this complication has now declined, probably as a result of improved obstetrical management (Ahvenainen, 1964). In the present study, a number of premature infants with hyaline membrane disease were found to have massive intracranial haemorrhage. All had suffered prolonged anoxia after birth, and were subsequently treated by artificial ventilation until death. Attention has been directed towards defining the role of anoxia, and in particular whether it is the cause of haemorrhage or whether it arises as a result thereof. The investigation has also been concerned with establishing whether the bleeding occurs as a chronic or an acute episode, and whether intermittent positive pressure respiration contributes in any way.