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Clinical manifestations and diagnosis of intraventricular hemorrhage in the newborn

Author
Lisa M Adcock, MD
Section Editors
Joseph A Garcia-Prats, MD
Douglas R Nordli, Jr, MD
Deputy Editor
Melanie S Kim, MD

INTRODUCTION

Intraventricular hemorrhage (IVH; also known as subependymal or germinal matrix hemorrhage) is an important cause of brain injury in premature infants. Although the incidence has declined since the 1980s, IVH remains a significant problem, as improved survival of extremely premature infants has resulted in a greater number of survivors with this condition [1,2].

The epidemiology, pathogenesis, clinical presentation, and diagnosis of IVH are discussed in this topic review. The management, complications, and outcome of IVH in the newborn are discussed separately. (See "Management and complications of intraventricular hemorrhage in the newborn".)

PATHOLOGY

Preterm infants — In preterm infants, the site of origin of bleeding is generally in small blood vessels in the subependymal or germinal matrix (also termed the ganglionic eminence), which is located between the caudate nucleus and the thalamus at the level of the foramen of Monro. Neuropathologic studies suggest that the hemorrhage is primarily within the capillary network, which freely communicates with the venous system, although bleeding can also occur from the arterial circulation. Vessels in this region occupy border zones between cerebral arteries and the collecting zone of the deep cerebral veins, and have increased permeability when subjected to hypoxia and/or increased venous pressure [3]. Bleeding may disrupt the ependymal lining and extend into the lateral ventricle. (See 'Germinal matrix fragility' below.)

Severity and grading of IVH — Severity of hemorrhage is based on whether the bleeding is confined to the germinal matrix region or if it extends into the adjacent ventricular system or white matter (intraparenchymal). The following grading system is used to define the extent of bleeding (table 1) [3]:

Grade I – Bleeding is confined to the germinal matrix (image 1 and image 2)

                               

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 24 00:00:00 GMT+00:00 2016.
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