INTRAVENTRICULAR HEMORRHAGE IN THE NEONATE YURIDIA, KENNEDY RT-29 NEONATAL

DEFINITION An intraventricular hemorrhage (abbreviated as IVH) is a bleeding into the brain's ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. It can result from physical trauma or from hemorrhaging in stroke.

How is the diagnosis of IVH made Cranial Ultrasound is the screening method of choice Up to half of infants with IVH may be asymptomatic According to the American Academy of Neurology and the Practice Committee of Child Neurology Society:  Routine ultrasound should be performed on all infants <30weeks gestage  Screening should be performed at 7-14 days & repeated at 36-40weeks CT or MRI offer no advantage in detection of IVH

Risk Factors for IVH 1. Prematurity: Occurs most frequently in infants born <32 weeks or <1500g Incidence is 26% for infants weighing g The highest prevalence is in the least mature infants Mortality: ~15% (worse prognosis with increasing severity 2. Timing: Virtually all IVH in premature infants occurs in first five days 50, 25, and 15% on the first, second and third day, respectively By the end of the first week, 90% of hemorrhages can be detected 3. Other Risk Factors: Intrapartum asphyxia Chorioamnionitis Hypoxemia Hypercarbia Pnuemothorax/Pulmonary Hemorrhage Maternal fertility treatment

Grading IVH ClassificationMedical nameWhat it means Grade ISubependymal or germinal matrix hemorrhage (SEH/GMH) The bleeding is restricted to the germinal matrix and blood has not entered the ventricles. Grade IIIntraventricular hemorrhage (IVH) Some blood is present in the ventricles, but not enough to enlarge them. Grade IIIVentriculomegaly (VM)Enough blood has entered the ventricles that the ventricles are enlarged. Grade IVParenchymal hemorrhage (IPH)The bleeding into the ventricles has resulted in a decreased blood supply to other parts of the brain, causing ischemic damage with subsequent bleeding.

IMAGES

INTRAPARENCHYMAL HEMORRHAGE Intraparenchymal ischemia/hemorrhage in periventricular area (sometimes called Grade (IV) IVH) Periventricular ischemia may lead to hemorrhagic infarct or to non-hemorrhagic infarct Areas of infarct become necrotic and are “cleaned up” to become holes periventricular leukomalacia (PVL) porencephalic cyst(s)

TREATMENT In most cases, the IVH does not produce any symptoms or signs since they are usually small bleeds. They are only visible on ultrasound scans of the baby’s head. The bleeding gradually stops and the blood vessels heal themselves. There are no immediate treatments necessary. If damage has occurred to brain tissue, this does not heal and there may be long-term problems with development. In more severe cases of IVH, other treatments may be necessary. Blood pressure must be monitored and maintained in the normal range. At times, the bleeding and pressure within the ventricles of the brain can interfere with the flow of cerebrospinal fluid (CSF). Over time, typically a few weeks, it may cause a condition called hydrocephalus, where there is a build-up of CSF in the ventricles of the brain due to blocked flow from blood clots. This causes enlargement of the baby’s head. The treatment of hydrocephalus may involve the surgical placement of a shunt, which is a thin tube that drains off the CSF from the brain to another part of the body such as the abdomen. Prior to surgery, CSF may be drained off using a needle to relieve pressure in the ventricles and relieve symptoms of increased pressure on the brain