Intraventricular Hemorrhage (IVH)

by Brian Alverson, MD

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    00:01 So let’s move on to the next issue of prematurity which is intraventricular hemorrhage.

    00:06 This is bleeding in the brain which can happen usually as a result of difficulty around the peripartum period.

    00:12 Perhaps, there was some late decelerations or placenta abrupta or something.

    00:18 Basically, this is bleeding at the subependymal germinal matrix of the brain.

    00:23 This happens in 25-40% of premature infants.

    00:28 So we routinely do head ultrasounds on all of these kids.

    00:33 There are certain risk factors for worse bleeds.

    00:35 One is extreme prematurity and the other is hypotension, hypothermia, metabolic acidosis or thrombocytopenia in the peripartum period.

    00:45 So these can vary from being essentially asymptomatic and having no consequences at all to being completely catastrophic.

    00:55 Eighty percent will occur within the first three days after birth.

    00:59 So the symptoms patients have if they’re having a symptomatic IVH, may be apnea where they hold their breath.

    01:06 They may have a seizure and the seizures can be very subtle.

    01:10 They may have sudden anemia because they bled into their brain.

    01:13 They may develop hypotension from blood loss or they may develop hypertension from increased ICP.

    01:22 We generally breakdown these bleeds into how severe they are because it give us some prognostic ability.

    01:29 Grade 1 bleeds tend to be not so bad or very mild is PVL or periventricular leukomalacia.

    01:37 Grade 1 bleeds involve just the germinal matrix.

    01:41 A grade 2 bleed involves up to 50% of the ventricle.

    01:47 A grade 3 bleed is more than 50% of the ventricle and a grade 4 bleed such as you can see here with that white stuff, that’s all blood, that’s a parenchymal bleed.

    01:58 It’s bled into the parenchyma and these have a much worse prognosis.

    02:02 Rarely, something like this can show up where the blood has actually prevented drainage of the CSF out of the ventricle and this baby may well need a shunt and has hydrocephalus.

    02:14 So the prognosis, like I said, depends on the severity of bleed.

    02:18 Generally, grade 1s do well.

    02:20 A grade 3, about 60% of those patients will have neurodevelopmental problems.

    02:26 In grade 4, 90% will have severe sequelae.

    02:31 This is a bad prognostic finding.

    02:34 So that’s my review of the common complications of prematurity in infants.

    02:40 Thanks for your time.

    About the Lecture

    The lecture Intraventricular Hemorrhage (IVH) by Brian Alverson, MD is from the course Neonatology (Newborn Medicine).

    Included Quiz Questions

    1. Grade 2
    2. Grade 3
    3. Grade 1
    4. Grade 4
    5. Grade 5
    1. Hyperbilirubinemia
    2. Hypotension
    3. No symptoms
    4. Hypertension
    5. Seizure

    Author of lecture Intraventricular Hemorrhage (IVH)

     Brian Alverson, MD

    Brian Alverson, MD

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    Excellent lecture
    By Jalil Z. on 16. August 2020 for Intraventricular Hemorrhage (IVH)

    Excellent lecture as usual. I feel more confident to understand the complications around prematurity.