CELLULAR REACTIONS TO SUBEPENDYMAL PLATE HAEMORRHAGE IN THE HUMAN NEONATE

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Abstract
The most important cause of death in human premature babies at the present time is intraventricular hemorrhage consequent to hemorrhage in the subependymal plate. Lesser degrees of plate hemorrhage can also have serious effects. It was possible to observe the reaction to such hemorrhages in 27 cases whose range of gestational age extended from 23-36 wk and survival from 4-59 days. The hemorrhage occurs in the 1st wk of life, usually in the 1st few days. The earliest reaction at 4 days was the presence of mononuclear phagocytes around the hemorrhage; these evolved to Fe pigment macrophages which were present in 18 of the 22 cases in which some reaction was detected. Subependymal astrocytic proliferation was seen at 11 days, related to ependymal disruption, but an astrocytic reaction around the hemorrhage and related to it was not seen until 14 days. Within the subependymal plate this reaction was scanty in fibril production and the cells were derived from differentiating astrocytes in the plate. In 1 case a more marked reaction was detected to hypoxic damage in the adjacent thalamus. The source of the phagocytes in these sites and the reasons for the rather slow astrocytic reaction are discussed.