So let’s move on to the next issue of prematurity
which is intraventricular hemorrhage.
This is bleeding in the brain
which can happen usually
as a result of difficulty
around the peripartum period.
Perhaps, there was some late decelerations
or placenta abrupta or something.
Basically, this is bleeding at the
subependymal germinal matrix of the brain.
This happens in 25-40%
of premature infants.
So we routinely do head
ultrasounds on all of these kids.
There are certain risk
factors for worse bleeds.
One is extreme prematurity
and the other is hypotension,
hypothermia, metabolic acidosis
or thrombocytopenia in
the peripartum period.
So these can vary from being
and having no consequences at all
to being completely catastrophic.
Eighty percent will occur within
the first three days after birth.
So the symptoms patients have if
they’re having a symptomatic IVH,
may be apnea where they hold their breath.
They may have a seizure and the
seizures can be very subtle.
They may have sudden anemia because
they bled into their brain.
They may develop hypotension
from blood loss
or they may develop hypertension
from increased ICP.
We generally breakdown
these bleeds into
how severe they are because it
give us some prognostic ability.
Grade 1 bleeds tend to be not so bad
or very mild is PVL or
Grade 1 bleeds involve
just the germinal matrix.
A grade 2 bleed involves up
to 50% of the ventricle.
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.
It’s bled into the parenchyma and
these have a much worse prognosis.
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.
So the prognosis, like I said,
depends on the severity of bleed.
Generally, grade 1s do well.
A grade 3, about 60% of those patients
will have neurodevelopmental problems.
In grade 4, 90% will have severe sequelae.
This is a bad prognostic finding.
So that’s my review of the common
complications of prematurity in infants.
Thanks for your time.