Intraventricular hemorrhage in the high‐risk preterm infant: Incidence and outcome

Abstract

To determine the incidence of subependymal (SEH) or intraventricular hemorrhage (IVH) and its short-term outcome, infants of less than 35 weeks' gestation who required intensive care were evaluated and computerized tomographic scans obtained. If the scans showed blood, serial scans were followed until the hemorrhage had resolved and ventricle size was stable. Hemorrhage was quantitated; Seventy-seven of 191 (40.3%) infants were shown to have SEH, IVH, or both; 22 of them (28%) died, and hemorrhage was thought to be the primary cause of death in 17. Fifty-five survivors (71%) with SEH, IVH, or a combination of the two had serial follow-up scans. Six had SEH alone; 49 had IVH. Severe progressive hydrocephalus developed in 12 (22%) infants. Thirty-seven (75.5%) die not show progressive hydrocephalus. The degree of hemorrhage in these 37 was mild in 14, moderate in 13, and marked in 10. Of those with progressive hydrocephalus, hemorrhage was marked in 8 and moderate in 4. Hydrocephalus resolved spontaneously in 4 of the 12. Medical treatment (repeated lumbar punctures) was successful in 3, but failed in 4. Hydrocephalus was managed by shunt surgery in 5. This study revealed that the quantity of blood is prognostically important with regard to both survival (p less than 0.001) and development of progressive hydrocephalus (p less than 0.05). Furthermore, hydrocephalus, even if progressive, may not necessitate surgical management;

Prenatal Diagnosis of Fetal Intracranial Hemorrhage at 25 Weeks of Gestation

“…Associated events in the pathogenesis of prenatal intracranial hemorrhage are unknown and can only be suspected from studies performed in the neonatal period [15]. Sudden changes in the cerebral blood pressure may cause hemorrhage in the fragile capillaries of the subependymal germinal matrix.…”

Developmental Outcome of Very Low Birth Weight Infants Requiring a Ventriculo-Peritoneal Shunt

“…Most investigators have found an incidence of hemorrhage of approximately 40% in this population, with subsequent posthemorrhagic ventricular dilatation in 25-50% of the infants [1][2][3][4], As ventricular dilatation may result in further brain injury, some form of therapeutic intervention may be indicated in order to prevent progres sive hydrocephalus, as well as preserve neurological integrity. The tradi tional therapy for progressive ventricular dilatation has been surgical placement of a ventriculo-peritoneal shunt.…”

Periventricular/Intraventricular Hemorrhage in the Newborn

“…Though incidence of PCH/IVH may be declining, 5,10 prospective studies have consistently reported a 40% to 50% of incidence of IVH in infants weighing 1500 g or less at birth. 3,4,11 At KKUH over a 4-year period, the incidence of PVH/IVH in infants under 35 weeks of gestation at birth was 20.9%, but rose to 40.6% in infants born at or before 30 weeks of gestation. Our incidence of 40.8% of PVH/IVH in infants weighing 1500 g or less is comparable to that reported in the literature.…”

“…Our incidence of 40.8% of PVH/IVH in infants weighing 1500 g or less is comparable to that reported in the literature. 3,4,10,11 It is understandable that the incidence of PVH/IVH should be higher in infants under 30 weeks of gestation because of the peculiarity of the blood supply and cerebrovascular physiology at this age. 12,13 Much of the bleeding arises from the germinal matrix.…”