Germinal matrix-intraventricular hemorrhage in the premature newborn: management and outcome

Survival of very premature infants has improved dramatically in recent decades; more than 85% of infants with birthweight between 500 g and 1500 g now survive the neonatal period [1,2]. Unfortunately, there has been no reduction in the rate of premature delivery during this time. On the contrary, recent data suggest that the proportion of very low birthweight (VLBW) infants (ie, birthweight less than or equal to1500 g) increased gradually to approximately 1.45% during the 1990s [3] (ie, more than 55,000 VLBW infants are born annually in the United States alone). Enthusiasm over the decline in mortality rate of VLBW infants has been tempered by concern about the high risk of neurologic morbidity in survivors, creating ethical dilemmas that are heightened by concerns in society about spiraling health care costs. Controversial questions (eg, How small is too small? How far should we go? How much can we afford? Who should decide?) should be addressed only after careful review of the current incidence of brain injury in this population. These ethical dilemmas are complicated further because the full extent of premature brain injury frequently is not detectable during early infancy by routine neurodiagnostic techniques and may not become evident clinically until many years later. There is a need to define the role of new diagnostic techniques for earlier, more accurate diagnosis of newborn brain injury. In addition, there is increasing realization that improvements in survival of premature newborns must be evaluated in the context of longitudinal assessments of survivors, at least until school age and perhaps into adulthood.