Intraventricular Hemorrhage (IVH)

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.

02:33 In a severe bleed, where there is increased IVH, this is a surgical emergency, and typically the neurosurgeon will put in an extraventricular drainage device to relieve the pressure.

02:46 In more mild bleeds, you might treat supportively. It really depends on the IVH.

02:53 It also depends on when you pick it up.

02:57 So that’s my review of the common complications of prematurity in infants.

03:03 Thanks for your time.