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.

    02:33 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.

    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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    Problema en traducción
    By Angel L. on 11. September 2023 for Intraventricular Hemorrhage (IVH)

    Hay problema con la traducción en los últimos minutos. En la parte de actualización no hay una traducción y se adelanta la traducción

    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.