Respiratory Distress Syndrome and Intracranial Hemorrhage: Cause or Association? Inferences From Surfactant Clinical Trials

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Abstract
Among preterm newborns, those with respiratory distress syndrome are at increased risk of intracranial hemorrhage. Three hypotheses have been offered as explanation for this association. In the biology hypothesis, respiratory distress syndrome in one way or another increases the risk of intracranial hemorrhage. Variations on this hypothesis incorporate specific adverse effects of respiratory distress, such as grunting (ie, increased intrathoracic pressure leads to increased cranial intravascular pressure), impaired cerebral blood flow, and acidosis. In the second hypothesis, treatment of respiratory distress increases the risk of intracranial hemorrhage. For example, rapid infusion of buffer for treatment of acidosis was once thought to influence the risk of bleeding into the brain, although substantiation has not been provided.

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