Question
A two-day-old infant dies in the intensive care unit. He was born at 25 weeks of gestation to an apparently healthy, 38-year-old female. He suffered from moderate respiratory distress secondary to hyaline membrane disease. Postmortem brain findings include a large left-sided intraventricular clot. Which of the following is the most likely cause of this finding?
| A. |
Postmortem artifact
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| B. |
Cephalhematoma
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| C. |
Berry aneurysm
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| D. |
Germinal matrix bleeding
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Show Answer
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Correct Answer � D
Explanation
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Ans. D. Germinal matrix bleeding
Explanation: lntraventricular hemorrhage (IVH) is a prominent cause of brain injury in the premature infant, typically developing within the first five days of life. Risk factors for IVH include birth before 32 weeks of gestation, birth weight of fewer than 1500 grams, intrapartum asphyxia, respiratory distress syndrome, and prolonged resuscitation. IVH most often begins in the germinal matrix, which is highly cellular and vascular in the subventricular region that generates neurons and glia during fetal development. No network fibers are present to support the vasculature in the germinal matrix, leaving it vulnerable to hemorrhage. Periods of hemodynamic instability that modify cerebral blood flov1 appear to increase the risk of bleeding. After 32 weeks of gestation, the germinal matrix has subsided in prominence, with an associated decline in cellularity and vascularity.
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