IVH

Most common form of intracranial

hemorrhage(subdural and subarachn
oid hemorrhage are lesscommon)20
% in infants <1500 g or <32 weeksIn
cidence varies inversely with gestatio
nal age >50% IVH occur in first 24 ho
urs of life,>50% IVH occur in first 24
hours of life,90% by 10 days90% by
10 days

Pathogenesis
Germinal matrix is a highly
vascular weakly supported structure
that is prone torupture and hypoxic-i
schemic injury

 IVH
Risk factors
Extreme prematurityBirth asphyxiaNeed
for vigorous resuscitationPneumothorax
Sudden elevations or fluctuations in BP
Other: labor, seizures, dyssynchronousv
entilation, hypothermia, hypercarbia, ac
idosis,rapid bicarbonate infusion, rapid
volumeinfusion, PDA/PDA ligation

Clinical Presentation includes:

On Physical Examination:
Alteration in mentation - seizures, posturing, coma or decreased
consciousnessApneaRespiratory distress including tachypnea and retractionsIrr
egular breathingFontannel - full or bulgingHypotension or blood pressure lability
HypnoticPallor Poor perfusionLaboratory Values:AcidosisBloody cerebrospinal flu
idHematocrit dropHypoglycemia

 The term Intraventricular Hemorrhage refers to all 4

grades.Hemorrhage refers to all 4 grades.The term
Periventricular HemorrhageThe term Periventricular He
morrhagerefers to a grade IV IVHrefers to a grade IV IV
H
.
Grade I: hemorrhage limited to the subependymalgerminal
matrixGrade II: hemorrhage in the subependymal
germinalmatrix with extension into the ventricular system but
without lateral ventricular dilationGrade III: hemorrhage in the
subependymal germinalmatrix with extension into the ventric
ular system withlateral ventricular dilatationGrade IV: hemorrh
age in the subependymal germinalmatrix with extension into t
he brain tissue (i.e.intraparenchymal hemorrhage)

Diagnosis
UsingSonography

Sonography is the Gold Standard for

bedsidediagnosis.

Grade I: hemorrhage limited to the subependymal

germinal matrix

 Grade II: Hemorrhage in

thesubependymal germinal matrixwit
h extension into the ventricular syste
m but without lateralventricular dilati
on
Grade III: Hemorrhage in
thesubependymal germinal matrix wi
thextension into the ventricular syste
mwith lateral ventricular dilatation