IVH of prematurity

Last modified by Hussein Abdallah on 2025/05/27 01:38

FACTS

#1 cause of hydrocephalus in preterm infants

Pathophysiology: alterations of cerebral blood flow through germinal matrix can lead to hemorrhage, as these vessels to not have typical components of the BBB. The matrix is a well-vascularized periventricular sub-ependymal area of the brain.

CONSULT

HPI

Common co-morbidities: apnea of prematurity, respiratory distress w/ ventilator dependence, anemia, E faecalis sepsis, PDA
Check for bradycardia / desaturations and ask NICU nurses
check weight (cannot operate on a human being < 2kg)

FOCUSED EXAM

check fontanelles
evaluate for dilated scalp veins

evaluate for sun-setting of pupils (forced downgaze)

if severe: transillumination of cranium
evaluate symmetry of spontaneous movements (hemorrhage may cause contralateral hemiparesis)

IMG

US is best modality, no transport, no radition
MRI is okay modality of child is safe to transport
CT least desirable, involves transport and radiation

evalute for periventricular leukomalacia

A/P

[ ] serial lumbar taps (pediatricians/neonatologists)
[ ] serial US
[ ] serial OFCs (use corrected age!)
[ ] CSF diversion:
- Ventriculoperitoneal Shunts
- Ventriculo-subgalael shunts
- Ommaya
- ETV (low success score)

Grades of IVH

Grade	Blood burden	Ventriculomegaly / Hydro
1	confined to germinal matrix	none
2	blood in ventricles	none, although may go on to develop hydro
3	blood in ventricles	yes
4	blood in ventricles + ruptures/dissection of clot into surrounding white matter	yes

Examples of Grade 3

Figure 1: Germinal matrix is just medial to the caudate

learn something useful — yasasiihitogomi: Germinal matrix hemorrhage...