Intraventricular haemorrhage
Like other problems of preterm infants, cerebral bleeding was barely known before special hospital units for ‘weaklings’ were established. Its symptoms were unspecific, the infants were considered miscarriages, and autopsies were rarely performed. Based on those postmortem findings, the theory arose at the end of the 18th century that brain haemorrhages in preterm infants result from birth trauma. Such mechanical explanations persisted for two centuries, even when it became ever more evident that this brain disorder was associated with postnatal respiratory distress. When in vivo imaging techniques (computed tomography, ultrasound scanning through the fontanelle) became available in the 1970s, the view changed and respiratory insufficiency was acknowledged as the major causative factor. Relying on these imaging techniques, Pape and Wigglesworth developed a model that explained the origin of periventricular haemorrhage and ischaemia in 1978. With the understanding of pressure-passive perfusion and cerebral flow dependent on carbon dioxide tension, the stage was set for effective preventive strategies.