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75-421: IRDS may refer to: Infant respiratory distress syndrome . a syndrome characterized by difficult breathing in premature infants International Roadmap for Devices and Systems , an international body for guiding the semiconductor industry Information Resource Dictionary System , a United States Federal Information Processing Standard used to capture metadata during

150-426: A perfluorocarbon such as perfluoromethyldecalin can reduce inflammation in swine model of IRDS. Chronic lung disease, including bronchopulmonary dysplasia , is common in severe RDS. The etiology of BPD is problematic and may be the result of oxygen, overventilation or underventilation. The mortality rate for babies greater than 27 weeks of gestation is less than 20%. Henrik Verder is the inventor and pioneer of

225-431: A complex lining of the air space. This layer reduces the surface tension of the fluid that lines the alveolar air space. Surface tension is responsible for approximately 2/3 of the inward elastic recoil forces. In the same way that a bubble will contract to give the smallest surface area for a given volume, so the air/water interface means that the liquid surface will tend toward being as small as possible, thereby causing

300-432: A glucocorticoid is given without testing the fetal lung maturity. The American College of Obstetricians and Gynecologists (ACOG), Royal College of Medicine and other major organizations have recommended antenatal glucocorticoid treatment for women at risk for preterm delivery prior to 34 weeks of gestation . Multiple courses of glucocorticoid administration, compared with a single course, do not seem to increase or decrease

375-649: A rapid bedside test that predicts IRDS at birth. Extracorporeal membrane oxygenation (ECMO) is a potential treatment, providing oxygenation through an apparatus that imitates the gas exchange process of the lungs. However, newborns cannot be placed on ECMO if they are under 4.5 pounds (2 kg), because they have extremely small vessels for cannulation , thus hindering adequate flow because of limitations from cannula size and subsequent higher resistance to blood flow (compare with vascular resistance ). Furthermore, in infants aged less than 34 weeks of gestation , several physiologic systems are not well-developed, especially

450-651: A rapid point-of-care method for predicting IRDS by measuring the lecithin-sphingomyelin ratio (L/S) in gastric aspirate (GA). The new method, which is based on mid‐red Fourier Transform Infrared spectroscopy (FTIR), was shown to measure the L/S ratio at birth with a high sensitivity. This rapid bedside test for surfactant components in gastric aspirate is also now available, and clinical trials of this new point-of-care test to determine surfactant need at birth are underway. Lung ultrasound, with appropriate expertise, equipment, and training, may offer an alternative way to diagnose

525-416: A ruptured cerebral aneurysm (focal outpouchings with weakened walls on the arteries on the brain surface that are prone to rupture). Symptoms of SAH include a severe headache with a rapid onset ( thunderclap headache ), vomiting , confusion or a lowered level of consciousness , and sometimes seizures . CT scan has 100% sensitivity of detecting SAH at 6 to 24 hours after symptoms onset. The diagnosis

600-450: A system life cycle. Topics referred to by the same term [REDACTED] This disambiguation page lists articles associated with the title IRDS . If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=IRDS&oldid=1037278058 " Category : Disambiguation pages Hidden categories: Short description

675-476: A week to 38 days in 2014. Additionally, this study yielded average prevalence rates of 260 cases per 1000 livebirths from the years of 2003 to 2014, which coincided with the results yielded by a report from the Vermont Oxford Network in 2008 of 300 per 1000 livebirths. Intracranial hemorrhage Intracranial hemorrhage ( ICH ), also known as intracranial bleed , is bleeding within

750-413: Is bleeding into the subarachnoid space —the area between the arachnoid membrane and the pia mater surrounding the brain . Trauma can also cause SAH when the arteries and veins coursing through the subarachnoid space are ruptured. It is usually located at the cerebral sulci near the vertex of the head and spare the basal cisterns on CT scan. Severe trauma can cause SAH in all parts of the brain. When

825-410: Is a lucid interval during which the patient regains consciousness after being knocked unconscious; this is then followed by deterioration of conscious state. When the epidural hematoma is large enough, it will cause mass effect on contralateral brain which lead to midline, subfalcine (below the falx cerebri ), and trans-tentorial (crossing tentorium cerebelli ) herniations. This phenomenon can cause

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900-490: Is a smaller form of hemorrhagic parenchymal contusion and are typically found in white matter . Such microhemorrhages are difficult to be detected on CT scan, but easily detected on gradient echo and susceptibility weighted imaging on MRI scan as hypointense susceptibility blooming. Such microhemorrhages are frequently associated with diffuse axonal injury and located near the grey -white matter junction. Epidural hemorrhage (extradural hemorrhage, EDH) which occur between

975-525: Is bleeding within the brain itself, or cerebral hemorrhage . This category includes intraparenchymal hemorrhage , or bleeding within the brain itself , and intraventricular hemorrhage , bleeding within the brain's ventricles (particularly of premature infants ). Intra-axial hemorrhages are more dangerous and harder to treat than extra-axial bleeds. Hemorrhagic parenchymal contusions and cerebral microhemorrhages are examples of traumatic intra-axial bleeds. Extra-axial hemorrhage, bleeding that occurs within

1050-399: Is characterized by collapsed air spaces alternating with hyperexpanded areas, vascular congestion, and, in time, hyaline membranes. Hyaline membranes are composed of fibrin , cellular debris, red blood cells , rare neutrophils and macrophages . They appear as an eosinophilic, amorphous material, lining or filling the air spaces and blocking gas exchange. As a result, blood passing through

1125-427: Is confined within suture lines, accumulation of additional blood will cause bulging in this space, and thus resulting in a typical "biconvex" appearance on CT scans. EDH can be due to arterial or venous rupture depending on the locations. Arterial injuries results in more rapidly growing hematoma when compared to venous injuries. At the pterion region, middle meningeal artery is most commonly affected. When fracture

1200-471: Is crossing areas where dural venous sinuses resides, venous hemorrhage can occur such as falx cerebri , tentorium cerebelli , and vertex (where superior sagittal sinus resides). Anterior temporal EDH is usually caused by sphenoparietal sinus . Such EDH is limited and does not require surgery because its extension is confined within the sphenosquamosal suture and the superior or inferior orbital fissures . In 20 to 50% of epidural hemorrhage cases, there

1275-584: Is diagnosed within hours of delivery and usually leads to morbidity and mortality in preterm infants. There are many risk factors that can potentially cause IRDS. The most common risks factors that can potentially cause IRDS include male gender, white race, late preterm delivery, maternal diabetes, perinatal hypoxia (exposure to low oxygen) and ischemia (decreased blood flow), and low birth weight. Seventy percent of babies diagnosed with respiratory distress syndrome are born between 29 and 34 weeks of gestational age and are 55% more likely to be male. A study conducted at

1350-415: Is different from Wikidata All article disambiguation pages All disambiguation pages Infant respiratory distress syndrome IRDS affects about 1% of newborns and is the leading cause of morbidity and mortality in preterm infants. Data have shown the choice of elective caesarean sections to strikingly increase the incidence of respiratory distress in term infants; dating back to 1995,

1425-426: Is further increased with recanalisation of veins or arteries. Several types of hemorrhages can occur such as petechial hemorrhages around the infarcted margin (HI1), confluent petechial hemorrhages within the infarcted tissue (HI2), hematoma occupying less than 30% of the infarcted tissue (PH1), hematoma involving greater than 30% of infarcted tissue with small mass effect (PH2), and hematoma involving greater than 30% of

1500-558: Is generally confirmed with a CT scan of the head. If CT scan is normal but SAH is still strongly suspected, lumbar puncture can be done at six to twelfth hours after the onset of headache. This is determine the presence of blood within the cerebrospinal fluid (CSF). Those with SAH will have blood and bilirubin within their CSF because of the degradation of their red blood cells . Meanwhile, those who has blood within CSF due to traumatic lumbar puncture will not have bilirubin within CSF. SAH

1575-468: Is generally located within basal cisterns , extends diffusely to all subarachnoid spaces ( cerebral sulci ) or into the ventricular system , or brain parenchyma . Modified Fisher scale is used to describe the volume and distribution of SAH, just predicting the probability of cerebral artery vasospasm after SAH. Treatment is by prompt neurosurgery or radiologically guided interventions with medications and other treatments to help prevent recurrence of

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1650-478: Is given with a small amount of continuous positive airway pressure (CPAP), and intravenous fluids are administered to stabilize the blood sugar, blood salts and blood pressure. CPAP application to preterm neonates with respiratory distress is associated with a reduction in respiratory failure, mechanical ventilation and mortality. However, CPAP is associated with an increased rate of pneumothorax compared to spontaneous breathing with or without supplemental oxygen. If

1725-580: Is important to determine whether there is nidal or perinidal aneurysm. Dural arteriovenous fistulae (DAVF) is the direct connection between dural or cerebral arteries with dural venous sinuses or cortical veins. It accounts for 10 to 15% of intracranial arteriovenous shunts. DAVF lacks a nidus. Signs and symptoms of DAVF are: headache, tinnitus , neurological deficits involving cranial nerves , and increased intracranial pressure. DAVF once ruptured, will produce intraparenchymal hemorrhage or SAH. Increase in number of vessels near dural venous sinuses as seen on CTA

1800-603: Is indeterminate, and greater than 55 indicates mature surfactant production (correlating with an L/S ratio of 2.2 or greater). Infant respiratory distress syndrome (IRDS) is the leading cause of death in premature infants.  Despite only 1% of all birth complications being attributed to respiratory distress syndrome, there is a significantly higher prevalence in prematurely born babies. Incidence rates of IRDS in premature infants born at 30 weeks of gestational age (GA) are at 50%, and rise even higher to 93% for infants born prematurely at 28 weeks of gestational age or younger. IRDS

1875-422: Is manifested by fast breathing (more than 60 breaths per minute), a fast heart rate , chest wall retractions (recession), expiratory grunting, nasal flaring, and blue discoloration of the skin during breathing efforts. As the disease progresses, the baby may develop ventilatory failure (rising carbon dioxide concentrations in the blood) and prolonged cessations of breathing (" apnea "). Whether treated or not,

1950-440: Is related to inhibition from the insulin that is produced in the newborn, especially those of diabetic mothers. Pulmonary surfactant is a complex system of lipids , proteins and glycoproteins that is produced in specialized lung cells called Type II cells or Type II pneumocytes . The surfactant is packaged by the cell in structures called lamellar bodies , and extruded into the air spaces. The lamellar bodies then unfold into

2025-399: Is suggestive of DVAF. 4DCT may increase the sensitivity of detecting DAVF. In MRI scans, susceptibility weighted imaging (SWI) and arterial spin labelling sequences (labelling protons in blood without the use of contrast media to determine blood flow) are useful in evaluating DAVF. The patterns of draining veins from the fistula determines the risk of DAVF rupture. Increased pressure within

2100-592: Is the most common cause of intracranial hemorrhage. It can cause epidural hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage. Other condition such as hemorrhagic parenchymal contusion and cerebral microhemorrhages can also be caused by trauma. Non-traumatic causes of hemorrhage includes: hypertension , cerebral amyloid angiopathy , hemorrhagic conversion of ischemic infarction, cerebral aneurysms, dural arteriovenous fistulae, cerebral venous sinus thrombosis , cerebral vasculitis and mycotic aneurysm . More than half of all cases of intracranial hemorrhage are

2175-440: Is the most common form of intracranial bleed caused by vasculitis. On CT scans, sulcal SAH is seen as hyperdensity within the cerebral sulcus, while on MRI, it is seen as hyperintensity on FLAIR sequence, and hypointensity on GRE/SWI sequence. DSA is important in making the diagnosis of vasculitis or vasculopathy. It is arterial outpouchings arise from distal cerebral arteries. These are pseudoaneurysm , caused by thrombus clogging

2250-536: Is used to determine the likelihood of a cerebral hemorrhage due to CAA. Definitive diagnosis of CAA is by performing brain biopsy CT scan may show hyperdense intra-axial hemorrhage in the subcortical region. Diffuse white matter hypodensities in both cerebral hemispheres may represents microangiopathic changes. On MRI these lesions will be presented as blooming artifact on gradient echo and susceptibility weighted imaging. 43% of those with infarcted brain tissue will develop hemorrhagic conversion. Risk of hemorrhagic

2325-480: The Sylvian fissure , and isolated SAH in the anterior interhemispheric fissure . These cases warrants investigations to look for aneurysms that can cause such bleeding. Intracranial bleed in hypertensive subjects usually occurs at 50 to 60 years of life with 30 to 50% chance of death. Such hemorrhages are typically located in the basal ganglia , cerebellum , or occipital lobes . Other location such as bleed within

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2400-416: The carotid canal , because in such cases, posttraumatic vasospasm can occur, thus cutting blood supply to the brain. Besides, intracranial hemorrhage that are atypical for trauma should also be investigated further with CT or MR angiography to look for other causes of intracranial bleeds apart from trauma causes. Such atypical patterns includes: isolated SAH in the basal cisterns , isolated large-volume SAH in

2475-423: The cerebral vasculature and germinal matrix , resulting in high sensitivity to slight changes in pH , PaO 2 and intracranial pressure. Subsequently, preterm infants are at unacceptably high risk for intraventricular hemorrhage (IVH) if administered ECMO at a gestational age of less than 32 weeks. Giving the baby's mother glucocorticoids speeds the production of surfactant. For very premature deliveries,

2550-403: The dura mater (the outermost meningeal layer) and the skull, is caused by trauma. It does not cross the suture lines of the skull because the superifical dural layer is attached tightly to the skull along the suture lines. Unless rarely, fracture involves the suture lines (more common in children), then epidural hematoma may cross the suture lines. As the blood accumulated in the epidural space

2625-558: The skull . Subtypes are intracerebral bleeds ( intraventricular bleeds and intraparenchymal bleeds ), subarachnoid bleeds , epidural bleeds , and subdural bleeds . Intracerebral bleeding affects 2.5 per 10,000 people each year. Intracranial hemorrhage is a serious medical emergency because the buildup of blood within the skull can lead to increases in intracranial pressure , which can crush delicate brain tissue or limit its blood supply. Severe increases in intracranial pressure (ICP) can cause brain herniation , in which parts of

2700-455: The ventricular system , expansion of bleeding, or increasing cerebral oedema on CT scan gives poorer prognosis. CT angiography (CTA) of brain can be performed to investigate the source of bleeding. An image during the delayed phase of the CTA may be taken to look for pooling of contrast that signifies active bleeding (known as "Spot sign"). Presence of "Spot sign" signifies poor clinical outcome for

2775-508: The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network studied premature infants born between 22 and 37 weeks and the outcomes leading to IRDS. This study was conducted from 2002 to 2008. The incidence rate of IRDS for 24 weeks was 98%, for 34 weeks the incidence is 5%, and for 37 weeks the incidence rate was less than 1%. The results demonstrate that

2850-495: The INSURE (Intubation Surfactant Extubation) and LISA (Less Invasive Surfactant Administration) methods combined with nasal CPAP ( Continuous Positive Airway Pressure ), very effective approaches to managing preterm neonates with respiratory distress. In 1989 he used this pioneering method to successfully treat the first premature infant with severe RDS. The INSURE method has been shown, through meta-analysis, to successfully decrease

2925-458: The Management of Respiratory Distress Syndrome highlight new possibilities for early detection, and therefore treatment of IRDS. The guidelines mention an easy to use rapid point-of-care predictive test that is now available and how lung ultrasound, with appropriate training, expertise and equipment, may offer an alternative way of diagnosing IRDS early. IRDS begins shortly after birth and

3000-572: The SAH volume is large, rarely it can cause cerebral infarction a few days after trauma due to arterial vasospasm. Although CT scan is performed more often than MRI to detect SAH, MRI is more sensitive than CT in this aspect. SAH shows hyperintense signal of Fluid-attenuated inversion recovery (FLAIR) sequence and blooming artifact on susceptibility weighted imaging (SWI). Computed tomography angiography (CT angiography) or Magnetic resonance angiography (MR angiography) should be done if fracture involves

3075-584: The UK first documented 2,000 annual caesarean section births requiring neonatal admission for respiratory distress. The incidence decreases with advancing gestational age , from about 50% in babies born at 26–28 weeks to about 25% at 30–31 weeks. The syndrome is more frequent in males, Caucasians, infants of diabetic mothers and the second-born of premature twins. IRDS is distinct from pulmonary hypoplasia , another leading cause of neonatal death that involves respiratory distress. The European Consensus Guidelines on

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3150-406: The air space to contract. By reducing surface tension, surfactant prevents the air spaces from completely collapsing on exhalation. In addition, the decreased surface tension allows reopening of the air space with a lower amount of force. Therefore, without adequate amounts of surfactant, the air spaces collapse and are very difficult to expand. Microscopically, a pulmonary surfactant-deficient lung

3225-528: The baby's condition worsens, an endotracheal tube (breathing tube) is inserted into the trachea and intermittent breaths are given by a mechanical device. An exogenous preparation of pulmonary surfactant , either synthetic or extracted from animal lungs, is given through the breathing tube into the lungs. Surfactant medications can decrease the risk of death for very low- birth-weight infants who are hospitalized by 30%. Such small premature infants may remain ventilated for months. A study shows that an aerosol of

3300-482: The bleeding and complications. Since the 1990s, many aneurysms are treated by a minimal invasive procedure known as endovascular coiling , which is carried out by instrumentation through large blood vessels. However, this procedure has higher recurrence rates than the more invasive craniotomy with clipping . Cerebral ateriovenous malformation (Cerebral AVM) is characterised by abnormal shunting between cerebral arteries and veins without going through capillaries. Instead

3375-584: The blood goes through a collection of small vessels from arteries to veins. These collection of abnormal small vessels is termed as "nidus". This condition happens in 0.1% of the population has a risk of 2 to 4% per year for intracranial bleeding. Once ruptured, it results in intraparenchymal hemorrhage, intraventricular hemorrhage and SAH. Rupture of cerebral AVM often occurs in young people and children. Cerebral AVM can be diagnosed by computed tomography angiography (CTA) brain, magnetic resonance angiography (MRA) brain, or digital subtraction angiography (DSA). DSA

3450-748: The brain are squeezed past structures in the skull. Symptoms include severe headache, nausea/vomiting, seizures, dizziness or lightheadedness or vertigo, one-sided facial drooping, one-sided numbness, weakness, tingling, or paralysis, speech problems, blindness, deafness, memory issues, attention problems, balance problems, coordination problems and decreasing level of consciousness or complete loss of consciousness. Coma and persistent vegetative state can result from intracranial hemorrhage. Brain stem hemorrhage may cause additional symptoms such as shortness of breath, dysphagia (difficulty swallowing), chewing problems, abnormal heart rate, and irregular heartbeat . Brain stem hemorrhage can cause cardiac arrest. Trauma

3525-430: The brain. Density of SDH reduces as it progresses from acute to chronic forms. However, areas with low density may not represent chronic SDH entirely as unclotted blood products that are due to active bleed can also give low density appearance on CT scans especially those with coagulopathy . Those with SDH that have same density with brain parenchyma may represent acute bleed such as those with anemia , arachnoid tear, and

3600-411: The cerebral cortex and intracranial bleed in people younger than 50 years should prompt further investigations on other causes of bleed such as brain tumour or cerebral arteriovenous malformation . The bleed can be very small without any significant effect on surrounding brain or large hemorrhage that exerts mass effect on adjacent brain. Follow up CT scan is recommended. Those with extension of bleed into

3675-407: The clinical course for the acute disease lasts about two to three days. During the first day, the child worsens and requires more support. During the second day, the baby may be remarkably stable on adequate support and resolution is noted during the third day, heralded by a prompt diuresis . Despite huge advances in care, IRDS remains the most common single cause of death in the first month of life in

3750-449: The collapsed alveoli of the lung. In addition, the lungs show bleeding, overdistention of airways, and damage to the lining cells. The lungs of infants with respiratory distress syndrome are developmentally deficient in a material called surfactant , which helps prevent the collapse of the terminal air spaces (the future site of alveolar development) throughout the normal cycle of inhalation and exhalation. This deficiency of surfactant

3825-516: The combined mortality and incidence of Bronchopulmonary Dysplasia (BPD) contrary to selective rescue surfactant treatment. Therefore, there is a need for a rapid diagnostic test to guide early targeted surfactant treatment. Professor Henrik Verder has worked with lung-maturity diagnostics on gastric aspirates obtained at birth for over 15 years. With the introduction of surfactant treatment for IRDS, Henrik Verder developed additional lung maturity tests based on gastric aspirates (GAS); for example,

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3900-477: The detection of epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, nonhemorrhagic cortical contusions , hemorrhagic parenchymal contusions, brainstem injuries, and white matter axonal injuries. If CT scan shows normal findings, but the subject has persistent neurological symptoms, MRI is also indicated. However, MRI safety concerns on metallic foreign bodies, limited availability, longer imaging time, high sensitivity to motion, and higher cost limits

3975-467: The developed world. Complications include metabolic disorders (acidosis, low blood sugar ), patent ductus arteriosus , low blood pressure , chronic lung changes and bleeding in the brain . The syndrome is frequently complicated by prematurity and its additional effect on other organ functions. The characteristic histopathology seen in babies who die from RDS was the source of the name "hyaline membrane disease". Waxlike layers of hyaline membrane line

4050-485: The distal arteries, which results in inflammation and small tears at the site of occlusion. These inflammation and thrombis can caused by infective endocarditis , artificial heart valve or other heart problems. Similar to vasculitis, rupture of mycotic aneurysm also causes SAH in cerebral sulci, mostly located in the vertex. If mycotic aneurysm is located more proximally, it will produce diffuse SAH pattern. CTA or MRA would produce focal outpouching or increase in diameter of

4125-516: The dural venous sinuses causes backpressure into the cortical veins, thus making cortical veins more prone to rupture. The risk of hemorrhage is graded by Cognard and Borden grading systems. These grading systems are based upon the DSA. Dural venous sinus thrombosis (DVST) and cortical venous thrombosis (CVT) commonly presents with headache, increased intracranial pressure, or seizures. DVST is more common than CVT. DVST are frequently caused by infections in

4200-585: The incidence of IRDS increases with decreasing age at birth. According to a study from the University of Miami's Department of Pediatrics and Division of Neonatology, from the time range of 2003 to 2014, respiratory distress syndrome prevalence jumped from 170 per 1000 preterm live births to 360 per 1000 preterm live births nationwide in the United States. This study population's duration under hospital care averaged 32 days in 2003, increasing by nearly

4275-584: The infarcted tissue with significant mass effect. However, only PH2 is clinically significant. Those who has infarction should be monitored frequently with CT brains to access hemorrhagic conversions or worsening vasogenic oedema that may require neurosurgical decompression. Dual energy CT scan maybe useful to differentiate the high densities caused by reperfusion hemorrhage (bleeding after endovascular stroke treatment) and high density due to iodinated contrast administered during cerebral angiography . Besides from head injury, it may occur spontaneously, usually from

4350-438: The infiltrate will outline the larger airways passages, which remain air-filled). In severe cases, this becomes exaggerated until the cardiac borders become indiscernible (a 'white-out' appearance). To improve clinical outcomes very early treatment with surfactant is necessary. However, only about half of infants with a gestational age (GA) below 30 weeks need surfactant treatment and prophylactic surfactant treatment increases

4425-412: The lung. The diagnosis is made by the clinical picture and the chest X-ray , which demonstrates decreased lung volumes (bell-shaped chest), absence of the thymus (after about six hours), a small (0.5–1 mm), discrete, uniform infiltrate (sometimes described as a "ground glass" appearance or "diffuse airspace and interstitial opacities") that involves all lobes of the lung and air-bronchograms (i.e.

4500-405: The lungs is unable to pick up oxygen and unload carbon dioxide. Blood oxygen levels fall and carbon dioxide rises, resulting in rising blood acid levels and hypoxia . Structural immaturity, as manifested by a decreased number of gas exchange units and thicker walls, also contributes to the disease process. Therapeutic oxygen and positive-pressure ventilation, while potentially life-saving, can damage

4575-497: The microbubble stability test and lamellar body counts (LBC) as well as a large randomised trial using lamellar body counts to guide surfactant treatment. However, a common problem with all these methods is dilution with foetal urine. Additionally, the methods are time‐consuming laboratory tests and are too slow to be used as a point‐of‐care test (POC) to guide surfactant treatment. Professor Henrik Verder , in collaboration with chemometric scientist Agnar Hoskuldsson , developed

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4650-672: The mixing of hemorrhage and CSF. SDH usually have high or mixed densities during first two days of trauma, followed by isodensity at 11 days after trauma, and hypodensity after 14 days of trauma. Membranes with granulation tissue can rupture within SDH, and give high density appearance on CT scan. Over a prolonged period of time, calcifications can form. SDH can be treated with burr hole drainage, craniotomy or port system placement for blood clot evacuation, or middle meningeal artery embolisation. Subdural hematoma maybe less acute than epidural hematoma due to slower blood accumulation, but it still has

4725-533: The potential to cause brain herniation that may require surgical evacuation. Clinical features depend on the site of injury and severity of injury. Patients may have a history of loss of consciousness but they recover and do not relapse. Clinical onset occurs over hours. Complications include focal neurologic deficits depending on the site of hematoma and brain injury, increased intracranial pressure leading to herniation of brain and ischemia due to reduced blood supply and seizures. A subarachnoid hemorrhage (SAH)

4800-515: The presence of phosphatidylglycerol (PG), and, more recently, the surfactant/albumin (S/A) ratio . For the L/S ratio , if the result is less than 2:1, the fetal lungs may be deficient in surfactant. The presence of PG usually indicates fetal lung maturity. For the S/A ratio, the result is given as milligrams of surfactant per gram of protein. A S/A ratio less than 35 indicates immature lungs, between 35 and 55

4875-1047: The result of hypertension. CT scan ( computed tomography ) of the brain (without any iodinated contrast ), is the initial imaging choice because of its high speed, good accessibility in hospitals, high sensitivity in detecting brain injuries or brain diseases, thus helping to triage patients in emergency department in a timely manner and urgent neurosurgical intervention can be administered. Examples of brain diseases that require urgent intervention are: large volume hemorrhage, brain herniation , and cerebral infarction . Other advantages of CT over MRI scan are ability to detect bony fractures, vascular injury, and cerebrospinal fluid (CSF) leak. It also does not need to screen for MRI safety of implants/foreign body especially for penetrating or blast injuries. Moreover, CT scans have also been used to train deep learning models to automatically perform intracranial hemorrhage detection. Deep learning models have been found to reach expert-level performance. However, MRI has higher sensitivity than CT scan for

4950-439: The risk of death or neurodevelopmental disorders of the child. In pregnancies of longer than 30 weeks, the fetal lung maturity may be tested by sampling the amount of surfactant in the amniotic fluid by amniocentesis , wherein a needle is inserted through the mother's abdomen and uterus. Several tests are available that correlate with the production of surfactant. These include the lecithin-sphingomyelin ratio (" L/S ratio "),

5025-412: The severity of IRDS. A semi-quantitative lung ultrasound score performed during bedside lung echography was first described by Brat et al. and found to correlate with the oxygenation status of infants with RDS. Since then, several studies have supported the use of lung ultrasound scores to earlier predict an initial dose of surfactant when compared to current oxygenation-guided recommendations. Oxygen

5100-636: The skull base, dehydration, thrombophilia , meningioma , and other dural tumours. On CT scans, brain parenchymal hemorrhage that does not confined to specific arterial territory along with hyperdense appearance on dural venous sinuses raises the suspicion of DVST. Further evaluation with CT venography, MR venography, and post gadolinium MRI provides accurate diagnosis of venous thrombosis and follow-up after treatment. These studies demonstrate thrombus as filling defect or lack of signal. Those with vasculitis may be presented with headache, behavioural changes, neurological deficits, or intracranial bleeding. Sulcal SAH

5175-479: The skull but outside of the brain tissue, falls into three subtypes: epidural hematoma, subdural hematoma, and subarachnoid hemorrhage. This condition most commonly occurred in those with significant head movement or head impact. It is caused by injuries of small arterial or venous vessels, causing hemorrhage within the brain parenchyma, and give rise to hyperdense lesion on CT scan. MRI is more sensitive than CT scan in detecting such small hemorrhagic contusions, with

5250-530: The subject to lose consciousness and eventually to death. Therefore, large EDH requires emergent surgical clot evacuation. Embolisation of middle meningeal artery is performed if the hemorrhage is medium or small. Subdural hemorrhage (SDH) results from tearing of the bridging veins in the subdural space between the dura and arachnoid mater . It can cross the suture lines, but not across dural reflections such as falx cerebri or tentorium cerebelli. Therefore, subdural hematoma always limited to one side of

5325-692: The subject. Cerebral amyloid angiopathy (CAA) is the deposition of Amyloid beta peptide protein within the brain. Accumulation of such peptide proteins within the walls of the arteries can cause weakening of the walls and causes microhemorrhages, SAH within the cerebral sulci or large cerebral intraparenchymal bleed. SAH in CAA can be differentiated from vasculitis by its presentations. SAH in CAA usually occurs in those who age more than 60 years, temporary motor and sensory deficits, and intracranial bleed in white matter adjacent to cerebral cortex. Basal ganglia, posterior fossa, and brainstem are spared. Boston criteria

5400-450: The use of mechanical ventilation and lower the incidence of bronchopulmonary dysplasia (BPD). Since its conception in 1989, the INSURE method has been academically cited in more than 500 papers. The first randomised study involving the INSURE method was published in 1994 and a second randomised study in infants less than 30 weeks gestation was published by the group in 1999. Based on the INSURE method, Henrik Verder has since developed

5475-426: The use of gradient echo sequence. Contusions are more commonly seen in the brain parenchyma near base of the skull such as inferior frontal lobes and temporal lobes as a result of Coup contrecoup injury . Those with parenchymal contusion would require frequent follow-up imaging because such contusions may grow large enough to become hemorrhage and exerts significant mass effect on the brain. Cerebral microhemorrhages

5550-444: The usefulness of MRI. Swirl sign on CT scan (areas of low densities with surrounding areas of high densities) is indicative of active intracranial bleeding, high chance of death within one month, and poor subject's function in three months if the subject is still alive. When ICP is increased the heart rate may be decreased. Types of intracranial hemorrhage are roughly grouped into intra-axial and extra-axial. Intra-axial hemorrhage

5625-433: The vessel. Meanwhile, GRE/SWI MRI sequence would produce focal hypointensity. Small mycotic aneurysms are difficult to be seen on CT or MRI. Thus, DSA is useful in identifying these lesions. For those who is already on blood thinners such as aspirin or clopidogrel for prevention of myocardial infarction or stroke , traumatic intracranial hemorrhage should prompt the use of platelet function assays ( PFA-100 ) to assess

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