Neonatal Intracranial Hemorrhage — Iatrogenic Etiology?

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Abstract
In this issue of the Journal, Simmons et al. present data relating intracranial hemorrhage to hypernatremia induced by vigorous therapy of neonatal acidosis with sodium bicarbonate. Before the implications of this work are discussed it may be useful to review some of the important features of intracranial hemorrhage in neonates, the dangers of hypernatremia and concomitant hyperosmolality, and the controversy concerning the use of sodium bicarbonate.There are three major, clinically important categories of intracranial hemorrhage that occur in the newborn period: subdural hemorrhage; primary subarachnoid hemorrhage; and periventricular ("intraventricular"), intracerebral hemorrhage. Subdural hemorrhage in neonates can result from . . .

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