IVH in Preterm Infants Sue Ann Smith
Preterm Neonates - IVH • Gestation usually less than 32 weeks, but may occur in more mature preterm infants • May rarely occur in the term neonate • The primary site of hemorrhage is the germinal matrix. • A secondary site is the choroid plexus - especially in the more mature infant
IVH timing • Set up for IVH usually present at birth • Bleeding usually not present before 24 hours, 75% of all IVH seen by 72 hours, and > 95% by 1 week of age. • Risk of new IVH after 1 weeks is very low. • Still need to follow for PVL, which is not usually detectable for 4-6 weeks by US.
Grading IVH by Ultrasound • Grade I - Germinal matrix hemorrhage (GMH) without extension into the ventricle • Grade II - GMH with extension of blood into ventricle, but without distension of ventricle. • Grade III - GMH with distension of ventricle.
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)
Cranial Ultrasound with Parenchymal Hemorrhage Coronal and sagittal views of intraparenchymal hemorrhage