Central nervous system patholgoy associated with mask ventilation in the very low birthweight infant: a new etiology for intracerebellar hemorrhages
Pape, K.E.; Armstrong, D.L.; Fitzhardinge, P.M.
Pediatrics 58(4): 473-483
1976
ISSN/ISBN: 0031-4005 PMID: 787912 Document Number: 108801
Mask-applied ventilatory support was noted to cause severe head molding in infants with birthweights under 1501 g. To determine if this molding was detrimental to the infant, the neonatal course and autopsy findings were reviewed for 106 infants. Twenty significant intracerebellar hemorrhages were found. An association between these hemorrhages and mask-applied positive pressure ventilation was demonstrated (P = .05). This relationship was maintained when all cases of generalized bleeding dyscrasia were removed (P = .021). The distortional forces produced by the mask attachment, together with the buffeting effect of intermittent positive-pressure ventilation, are probably causally related to the production of intracerebellar hemorrhages by direct contusion, by ischemic stasis or by altered venous drainage. Strong caution should be used when dealing with the small premature infant in using any attachment device that causes molding of the cranial vault, particularly in the occipital area.