In preterm infants, intraventricular haemorrhage and germinal matrix haemorrhage are the most widely reported neurological disorders. Approximately 12,000 infants each year are diagnosed with germinal matrix haemorrhage or intraventricular haemorrhage in the United States. Research
In 2002, a Dutch retrospective study analysed cases where neonatologists had intervened and drained CSF by lumbar or ventricular punctures if ventricular width (as shown on ultrasound) exceeded the 97th centile as opposed to the 97th centile plus 4 mm. Professors Whitelaws original Cochrane review published in 2001 as well as evidence from previous randomised control trials indicated that interventions should be based on clinical signs and symptoms of ventricular dilatation. An international trial has instead looked an early (97th centile) versus late (97th centile plus 4 mm) for intervening and draining CSF.DRIFT has been tested in an international randomised clinical trial; although it did not significantly lower the need for shunt surgery, severe cognitive disability at two years Bayley (MDI <55) was significantly reduced. Repeated lumbar punctures are used widely to reduce the effects in increased intracranial pressure and an alternative to ventriculoperitoneal (VP) shunt surgery that cannot be performed in case of intraventricular haemorrhage. The relative risk of repeated lumbar puncture is close to 1.0, therefore it is not statistically therapeutic when compared to conservative management and does raise the risk of subsequent CSF infection. References
External links

00511 at CHORUSUltrasound Pictures of Germinal Matrix IVH MedPix Image Database
Spectrum of susceptibility
Tobramycin has a narrow spectrum of activity and is active against Gram-positive Staphylococcus aureus and various Gram-negative bacteria. Clinically, tobramycin is frequently used to eliminate Pseudomonas aeruginosa in cystic fibrosis patients. The following represents the minimum inhibitory concentration (MIC) susceptibility data for a few strains of Pseudomonas aeruginosa:

Pseudomonas aeruginosa -  <0.25 µg/mL – 92 µg/mL [ref?] Pseudomonas aeruginosa (non-mucoid) – 0.5 µg/mL - >512 µg/mL [ref?] Pseudomonas aeruginosa (ATCC 27853) – 0.5 µg/mL – 2 µg/mLThe MIC for Klebsiella pneumoniae, KP-1, is 2.3±0.2 µg/mL at 25 °C [unpublished]. Contraindications
Tobramycin is contraindicated in people with hypersensitivity against aminoglycoside antibiotics. The Infusion is also contraindicated in people with myasthenia gravis. Side effects
Like other aminoglycosides, a major side effect for tobramycin is ototoxicity or a loss of equilibrioception, or both in genetically susceptible individuals. Other side effects include nephrotoxicity, neuromuscular toxicity, and hypersensitivity reactions. Nephrotoxicity can be particularly worrisome when multiple doses accumulate over the course of a treatment or when the kidney concentrates urine by increasing tubular reabsorption during sleep. Adequate hydration may help prevent excess nephrotoxicity and subsequent loss of renal function. For these reasons parenteral tobramycin needs to be carefully dosed by body weight, and its serum concentration monitored. Tobramycin is thus said to be a drug with a narrow therapeutic index. Interactions
Muscle relaxants and diethylether can add to the neuromuscular blocking effects of tobramycin.Methoxyflurane, when used as an inhalational anesthetic, can aggravate the nephrotoxic effects of injected tobramycin.