IVH

Most common form of intracranial hemorrhage(subdural and subarachnoid hemorrhage are lesscommon)20% in infants <1500 g or <32 weeksIncidence varies inversely with gestational age >50% IVH occur in first 24 hours of life,>50% IVH occur in first 24 hours of life,90% by 10 days90% by 10 days
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Pathogenesis Germinal matrix is a highly vascular weakly supported structure that is prone torupture and hypoxicischemic injury

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IVH Risk factors Extreme prematurityBirth asphyxiaNeed for vigorous resuscitationPneumothoraxSudden elevations or fluctuations in BPOther: labor, seizures, dyssynchronousventilation, hypothermia, hypercarbia, acidosis,rapid bicarbonate infusion, 4/20/12

Clinical Presentation includes: On Physical Examination: Alteration in mentation - seizures, posturing, coma or decreased consciousnessApneaRespiratory distress including tachypnea and retractionsIrregular breathingFontannel - full or bulgingHypotension or blood pressure labilityHypnoticPallor Poor perfusionLaboratory Values:AcidosisBloody cerebrospinal fluidHematocrit dropHypoglycemia

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The term Intraventricular Hemorrhage refers to all 4 grades.Hemorrhage refers to all 4 grades.The term Periventricular HemorrhageThe term Periventricular Hemorrhagerefers to a grade IV IVHrefers to a grade IV IVH . Grade 4/20/12 I: hemorrhage limited to the

Diagnosis UsingSonography

Sonography is the Gold Standard for bedsidediagnosis.

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Grade I: hemorrhage limited to the subependymal germinal matrix

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Grade II: Hemorrhage in thesubependymal germinal matrixwith extension into the ventricular system but without lateralventricular dilation Grade III: Hemorrhage in thesubependymal germinal matrix withextension into the ventricular systemwith lateral ventricular dilatation

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