A male 24 was born at 246/7 weeks of gestation. Newborn weighed 540g and Apgar score 4/6/7. He was intubated in the delivery room due respiratory effort and during the first hours of life received endotracheal surfactant. Child remain stable without need of inotropic support and FiO2 of 25%. According to the unit protocol was monitored with a cerebral near-infrared spectroscopy (NIRS) and at 36h there was a sudden drop from values of 80 to 40. Diagnosis of shock was made and inotropic support and increase in ventilator settings. A cranial point of care ultrasound revealed a real time bilateral bleeding from the germinal matrix-intraventricular hemorrhage (videoclip 1 available online, Supplementary Fig. 1) with blood inside both lateral ventricles and the occipital horns (Figs. 1 and 2). Emergency transfusion was given and NIRS improved to 75 allowing to decrease inotropic support and respiratory support.

Figure 1

(0.22MB).

Figure 2

(0.24MB).