Furthermore, due to excessive swelling of the underlying brain, we decided to perform dural incisions instead of flap durotomy. No bony bridge was left above the superior sagittal sinus in the area of the craniectomy undercutting and smoothing was also performed at the edge of the parietal bone. The patient was then operated using a wide decompressive craniectomy that encompassed bilaterally frontal and temporal areas, and extended as far as possible in the parietal bone. The pupils were checked immediately before the operation, but no recovery was observed. A reassessment of the patient's condition led to a decision for a final attempt at salvaging the patient by performing decompressive craniectomy. Initial decision was for conservative treatment using mannitol, hyperventilation, and barbiturate coma that controlled the ICP in a range of 17–27 mmHg, but despite that, mydriasis was resistant for >12 h. On the afternoon of the 7 th post-injury day, while in ICU care, the patient presented an increase in ICP (>25 mmHg with surges of >30) and bilateral non-reactive mydriasis (7 mm). Until the baby has passed 32 weeks post-menstrual age, there is no point looking for pupillary light reflexes, and the pupils will look fixed and dilated.Brain CT scan 24 h post-admission, showing the small left frontal epidural hematoma, slight improvement of brain edema and the tip of the ICP catheter There are a couple of more recent publications, but they don’t really add anything. The pupils of babies with any grade of hemorrhage (1 to 4) are not larger and do not have different reactions to light than those without hemorrhage. 1994 9(4):440-2. The answer to the question in the title is no. Are the pupils of premature infants affected by intraventricular hemorrhage? J Child Neurol. The proportion having a detectable response to light increased, and most were reacting by 32 weeks. The UCLA group again, this time with a cohort of 30 babies who were examined every week, they were all less than 31 weeks at the first examination and none of them reacted at that time. The fixed and dilated pupils of premature neonates. A similar study from Birmingham, England followed 50 babies, and found similar things, the few babies who responded before 31 weeks all had a slow reaction. Pupillary diameter and reaction to light in preterm neonates.

Pupillary light responses were usually absent before 30 weeks PMA, and only reliable after 32 weeks. This group from UCLA studied prospectively pupils of 100 babies from 26 weeks through to 46 weeks, with a standardized methodology pupils were larger in mm for more immature infants, even though their eyes are a bit smaller. The first of these, chronologically, is from 1989 Isenberg SJ, et al. I decided to go back through the literature to find out what was actually documented in peer-reviewed publications, and found, for a change, some good quality data. This post is in response to my trying to find out what had been published about this phenomenon, when a case in our NICU raised a teaching point. There is a reason we don’t perform pupillary reactions to light in preterm babies, and that is that they don’t react.

Cause fixed dilated pupil