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Today there is a controversy about the demand for the preservation of human life at any price. Special difficult problems result from intensive care of premature and newborn infants. The clinical criterions of cerebral death are different to those of adults, special investigations are restricted in their application. Often you cannot be sure of the prognosis in spite of knowing the diagnosis. Should the competent parents decide with us about the renunciation of a -- further -- intensive care? It is necessary to value all available factors to take the right decision. The paper wants to inform about some important criterions and stimulate the discussion.

22 premature infants with a birth weight less than 1500 g were studied by computed tomography. All of them needed intensive care therapy and had symptoms, which may have been caused by cerebral haemorrhage. In 15 cases (= 68%) we found subependymal and intraventricular bleeding. Clinical data showed that ventilated premature infants with subependymal and intraventricular haemorrhage needed respiratory support in the first hours p.p. because of hyaline membrane and aspiration syndroms. Premature infants without cerebral haemorrhage were ventilated much later (mean 96 h. p.p.). All patients with intraventricular haemorrhage and ventricular enlargement with and without parenchymal haemorrhage (grade III and IV) died. Prematures with subependymal haemorrhage (grad I) and intraventricular haemorrhage without ventricular dilation (grade II) may survive, depending on eventually present pulmonary complications. The introduction of computed tomography in the examination of the CNS on prematures can therefore help to give an early prognosis.

60 premature and newborn infants with clinical evidence of hypoxia or traumatic encephalopathy were examined by cranial computerized tomography (CCT) during the first fortnight of life and their findings compared with those of a "control group", consisting of 7 infants with malformations. 48 patients showed pathologic findings in the initial CCT. With regard to type, topography and extension, two groups with two subgroups could be outlined: 1. lesions with low density due to hypoxic-necrotizing alterations. a) Bilateral in the white matter around the frontal and occipital horns of the lateral ventricles in both, premature and fullterm newborn infants. b) Corresponding to vascular distribution, focal or global, involving both gray and white matter in both, premature and newborn infants. 2. lesions with high density due to hemorrhages. a) Subependymal and intraventricular, mainly in asphyxiated premature infants. b) Subdural and intracerebral, probably of traumatic origin, involving premature and fullterm newborn infants. The morphological findings in the initial CCT were compared with the outcome in each case. Thus, it was possible to distinguish certain morphological patterns significantly associated with prognosis. 14 patients (23.3%) died in the newborn period. The surviving 46 children (76.7%) were at least once re-examined by CCT and followed up during 6-24 months. 16 patients (26.7%) had a normal development. 12 (20%) showed developmental retardation. 18 (30%) suffered from neurological sequela. Frequently the early follow-up CCT showed characteristic patterns. We believe, that the great number of pathologic findings with essential information warrant the application of CCT in premature and fullterm newborn infants with persistent neurological signs. Perhaps our CCT observations will lead to the consequence of a more controlled high care regimen.