Intraventricular haemorrhage and periventricular leukomalacia — structured clinical encounter

Station brief (candidate)

You are the neonatal registrar. A 26-week-gestation infant, birthweight 760 g, is intubated and ventilated for respiratory distress syndrome. Antenatal steroids were given. At 36 hours of life, after a witnessed pneumothorax that required drainage, the infant has a sudden fall in haemoglobin from 145 to 88 g/L, a metabolic acidosis, a fall in blood pressure, and three brief focal seizures. The anterior fontanelle is bulging. The team asks you to establish the diagnosis and immediate management. You then proceed to the cranial-ultrasound result, the grading, the prevention discussion, and the prognostic counselling. You have 12 minutes with the team and 5 minutes for examiner discussion. ^[1]