Intraventricular Hemorrhage: An Update

1993 ◽  
Vol 8 (4) ◽  
pp. 157-176 ◽  
Author(s):  
Karl C.K. Kuban ◽  
Joseph J. Volpe
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Single Agent ◽  
Survival Rates ◽  
Pharmacological Interventions ◽  
Germinal Matrix ◽  
Vascular Integrity ◽  
The Matrix ◽  
Prenatal Interventions

Although the incidence of intraventricular hemorrhage (IVH) has decreased in recent years, the increasing survival rates for the smallest premature infants indicate that the lesion will continue to be a major problem in neonatal intensive care facilities. We review prenatal, perinatal, and postnatal variables that have been associated with enhanced risk of IVH and address some of the methodological limitations of previously reported studies. The neuropa-thology is characterized by bleeding into the subependymal germinal matrix, with subsequent rupture into the lateral ventricle. The pathogenesis of IVH relates to intravascular, vascular, and extravascular factors. Intravas-cular factors are those that relate primarily to control of blood flow and pressure in the microcirculation of the germinal matrix. Vascular factors relate to the microcirculation of the matrix, the site of initial bleeding. A maturation-dependent alteration of vascular integrity and a vulnerability of matrix vessels to injury appear important. Extravascular factors include those relevant to mesenchy-mal and glial support for matrix vessels and to local fibrino-lytic activity in the germinal matrix. Prognosis in the setting of IVH relates to the mechanisms of brain injury, the most important of which is pcriventricular hemorrhagic infarction, often inappropriately called grade IV IVH and often associated with subsequent motor and cognitive deficits. Prevention of IVH remains the most important goal. Prenatal interventions include prevention of premature birth, transportation of premature infants to a tertiary facility in utero rather than after birth, possibly prenatal administration of phenobarbital or vitamin K, and optimal management of labor and deliver. Postnatal interventions include careful newborn resuscitation, correction or prevention of major hemodynamic disturbances, and correction of abnormalities of coagulation. Postnatal pharmacological interventions that have been studied in detail include phenobarbital, indomethacin, ethamsylate, and vitamin E. No single agent among this group has been shown consistently to lead to a decrease in incidence and severity of IVH.

Intraventricular Hemorrhage in Premature Infants

1980 ◽  
Vol 2 (5) ◽  
pp. 145-153
Author(s):  
Joseph J. Volpe
Keyword(s):  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Premature Infant ◽  
Intracranial Hemorrhage ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Survival Rates ◽  
Clinical Importance ◽  
Subdural Hemorrhage

Four major varieties of intracranial hemorrhage can be recognized in the neonatal period: (1) subdural hemorrhage, (2) primary subarachnoid hemorrhage, (3) intracerebellar hemorrhage, and (4) periventricular-intraventricular hemorrhage.1 Subdural hemorrhage, often related to obstetrical trauma, now is an uncommon lesion in most medical centers. Primary subarachnoid hemorrhage, although very common, is rarely of major clinical importance, because of its venous origin and self-limited course. Intracerebellar hemorrhage, commonly observed at postmortem examination of the small premature infant but rarely documented during life, is of uncertain clinical significance. Periventricular-intraventricular hemorrhage is the most common and serious variety of neonatal intracranial hemorrhage. The enormous importance of this lesion is linked to the remarkable improvements in recent years in neonatal intensive care and, as a consequence, in survival rates for small premature infants. Because periventricular-intraventricular hemorrhage is characteristic of the premature infant (particularly the infant less than approximately 32 weeks gestation), the lesion has reached nearly epidemic proportions in modern neonatal intensive care facilities. INCIDENCE The remarkably high incidence of periventricular-intraventricular hemorrhage is demonstrated dramatically by studies in which premature infants were subjected to computed tomography (CT) scan routinely within the first week of life (Table 1). Thus, 40% to 45% of all such infants exhibited periventricular-intraventricular hemorrhage.2,3

Prematurity and Intraventricular Hemorrhage

2019 ◽  
pp. 19-29
Author(s):  
Catherine A. Mazzola ◽  
Tatiana Huk Sikorskyj
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Imaging Modality ◽  
Treatment Options ◽  
Infantile Hydrocephalus ◽  
Cerebrospinal Fluid Diversion ◽  
Radiologic Imaging ◽  
Evidence Based Guidelines ◽  
Symptoms And Signs

Intraventricular hemorrhage caused by bleeding in the germinal matrix is a complication often seen in premature infants. Variations in cerebral blood flow may lead to rupture of the fragile, immature blood vessels due to their inability to autoregulate or accommodate changes in cerebral perfusion. Post-hemorrhagic hydrocephalus (PHH) may lead to significant neurologic compromise and can be diagnosed by assessing for symptoms and signs of infantile hydrocephalus, followed by radiologic imaging. Treatment options may include temporary and permanent cerebrospinal fluid diversion. Head ultrasound is a common imaging modality used for hydrocephalus surveillance in infants during their postnatal hospital stay in the neonatal intensive care unit. Evidence-based guidelines for the treatment of PHH have been published by the Joint Guidelines Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.

scholarly journals Investigation of the relationship between umbilical cord pH and intraventricular hemorrhage of infants delivered preterm

2019 ◽  
Vol 65 (5) ◽  
pp. 647-656
Author(s):  
Ali Mazouri ◽  
Mahtab Massahi ◽  
Nasrin Khalesi ◽  
Ladan Younesi asl ◽  
Mandana Kashaki
Keyword(s):  
Umbilical Cord ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Blood Gases ◽  
Blood Gas ◽  
The Third ◽  
The Relationship ◽  
Type Of Delivery ◽  
Control Study

SUMMARY OBJECTIVE: We measured the level of pH gases in premature infants at birth, and examined the relationship between brain ultrasonography on the third and seventh day after birth. A case-control study conducted at the Neonatal Intensive Care Unit (NICU) of Shahid Akbar Abadi Hospital, Iran, during the years 2016-2017. METHODS: All premature infants who were admitted to NICU were enrolled in the current study. At birth, a blood gas sample was taken from the umbilical cord of the infants. On the third and seventh day after birth, an ultrasound of the brain of each neonate was performed by a radiologist. The umbilical cord was evaluated for blood gases in 72 neonates (mostly boys). RESULTS: Sixty-six newborns had normal sonography, and 16.7% (12 cases) had anomalies. A total of 75% of the 8 infants with intravenous bleeding were girls, which were significantly different from those in the non-hemodynamic group (62.5% male) (P 0.049). However, the type of delivery, mean weight, height, head circumference, the circumference of the chest, and Apgar score did not differ between the two groups. Mean pH, HCO3– and PCO2 in umbilical cord blood gas samples were not significantly different between the two groups with or without intraventricular hemorrhage (IVH). Although it was not related to gender and type of delivery in newborns CONCLUSION: Blood gases do not help in determining the occurrence of IVH in infants. Nevertheless, it is associated with immaturity and fetal age.

The role of intracranial hypotension in neonatal intraventricular hemorrhage

1983 ◽  
Vol 58 (2) ◽  
pp. 204-209 ◽  
Author(s):  
E. Scott Conner ◽  
Antonio V. Lorenzo ◽  
Keasley Welch ◽  
Brent Dorval
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Intracranial Hypotension ◽  
Intraventricular Hemorrhage ◽  
Rabbit Model ◽  
Germinal Matrix ◽  
Content Type ◽  
Ventricular Hemorrhage ◽  
Fine Print

✓ Most preterm infants develop transient intracranial hypotension, which reaches its lowest level on the 2nd day of life. This corresponds to the time when most neonatal intraventricular hemorrhage (IVH) occurs. In order to test the hypothesis that intracranial hypotension may have an etiological role in the development of IVH in premature infants, the authors induced intracranial hypotension in the preterm rabbit by the intraperitoneal injection of glycerol. The rabbit model is well suited for this study because this animal is at risk of developing spontaneous germinal matrix and ventricular hemorrhage. Compared to control littermates, the glycerol-treated animals exhibited a greater than 3.5-fold incidence of germinal matrix and intraventricular hemorrhage.

Anesthesia for Premature Infants and Micropremies

2019 ◽  
Author(s):  
Elaine Ng
Keyword(s):  
Intensive Care ◽  
Inguinal Hernia ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Anesthetic Management ◽  
Collaborative Approach ◽  
Careful Planning ◽  
Anesthetic Agents ◽  
Time Of Presentation

Advances in medicine has led to the increased survival of micropremies and premature infants. The anesthetic management for these patients has unique considerations and should only be provided by experts at specialized pediatric centers. Technical procedures and monitoring can be challenging due to their small size. Related to the physiology and immaturity of the airway, respiratory, cardiac and neurologic systems, there is an increased perioperative risk that may be related to hypoxemia and apnea and rapid desaturation, reversal of intracardiac shunts, and intraventricular hemorrhage. Immature renal and hepatic systems are related to decreased drug metabolism and demand careful and accurate administration of medications. The patients are prone to hypothermia and hypoglycemia. In addition, there may be congenital anomalies, syndromes, or other metabolic issues that may not have been fully worked up at the time of presentation for anesthesia. Emerging information related to potential neurotoxicity related to exposure to anesthetic agents has led to continual research and understanding of these mechanisms in order to provide the safest care. A meticulous approach, careful planning, and collaborative approach with the multidisciplinary neonatal team are essential to ensure the best possible outcome for this unique patient population.  This review contains 3 figures, 4 tables, and 36 references. Keywords: inguinal hernia repair, micropremies, prematurity, neonatal anesthesia, neurotoxicity, neonatal intensive care, necrotizing enterocolitis, preterm infants

Abstract TP400: Evoked Functional Cerebral Hemodynamic and Metabolic Responses in Premature Infants with and without Germinal Matrix Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Pei-Yi Lin ◽  
Fang-Yu Cheng ◽  
Katherine Hagan ◽  
Yvonne Sheldon ◽  
Ellen P. Grant ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Continuous Wave ◽  
Oxygen Metabolism ◽  
Correlation Spectroscopy ◽  
Germinal Matrix ◽  
Germinal Matrix Hemorrhage

We have created an innovative new method which uses frequency domain near-infrared spectroscopy (FDNIRS) in combination with diffuse correlation spectroscopy (DCS) to quantitatively measure cerebral blood flow (CBF) and oxygen metabolism (CMRO 2 ) right at the infant’s bedside. We have previously found CBF and CMRO 2 are more sensitive indicators of cerebral pathophysiology than hemoglobin saturation (SO 2 ). Using FDNIRS-DCS, we had found extremely premature infants with germinal matrix hemorrhage (GMH) have lower cerebral blood flow (CBF) and oxygen metabolism (CMRO 2 ) than gestational age-matched controls. For this study, we investigate whether GMH, along with age and hematocrit levels, affect evoked hemodynamic responses. The study protocol was reviewed and approved by the Institutional Review Board for Partners Healthcare. We enrolled eleven premature infants in the neonatal intensive care unit at Brigham and Women’s Hospital. Three of them had Grade I GMH diagnosed by head ultrasound on the first three days of life. We integrated continuous wave NIRS (CWNIRS) with DCS to measure dynamic changes of cerebral hemoglobin concentrations (HbO) and CBF in response to somatosensory stimuli. For each measurement, we measured differential path length factors and baseline cerebral hemoglobin concentrations with FDNIRS to quantify relative hemodynamic and metabolic changes (rHbO, rCBF and rCMRO 2 ) in response to tactile stimulation. We observed a faster response time to reach peak value in preterm infants with increasing postmenstrual age (PMA), demonstrating the response matures with age to become more adult-like (r=-0.513, p=0.007). In addition, infants measured at older PMA tend to have responses with a larger undershoot in HbO. However, the HbO undershoot did not translate into an undershoot in CMRO 2 . The HbO undershoot may therefore be a consequence of low hematocrit during the first two months of life which results in insufficient oxygen supply and leads to abnormally large oxygen extraction from the blood. We found the activation pattern of Grade I GMH infants did not differ from premature infants without hemorrhage. The study is ongoing and shows our method is suitable to measure cerebral maturation in neonates with hemorrhage.

scholarly journals Relationship between intraventricular hemorrhage and acute kidney injury in premature infants and its effect on neonatal mortality

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mountasser M. Al-Mouqdad ◽  
Roya Huseynova ◽  
Thanaa M. Khalil ◽  
Yasmeen S. Asfour ◽  
Suzan S. Asfour
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Neonatal Mortality ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Direct Relationship ◽  
Kidney Injury ◽  
Study Population ◽  
The Relationship

AbstractIntraventricular hemorrhage (IVH) and acute kidney injury (AKI) are important neonatal morbidities in premature infants. This study aimed to investigate the relationship between IVH and AKI in premature infants and whether this association affects the incidence of neonatal mortality. Infants [gestational age (GA) ≤ 32 weeks; birth weight (BW) < 1500 g] were retrospectively evaluated in a large tertiary neonatal intensive care unit. Of 710 premature infants, 268 (37.7%) developed AKI. Infants with IVH were more likely to have AKI than those without IVH. Infants with severe IVH had a higher incidence of AKI than infants with mild IVH. Infants younger than 28 weeks with IVH were more likely to have AKI than those without IVH. An association between IVH grades and AKI stages was observed in the overall study population, in infants with GA < 28 weeks, and in infants with GA between 28 and 32 weeks. Mortality was increased 1.5 times in infants with IVH and AKI compared with that in infants with IVH but without AKI. Furthermore, mortality was increased in infants with IVH and AKI compared with infants without IVH or AKI. This study shows a direct relationship between the severity of IVH and the degree of AKI; both IVH and AKI increase the incidence of neonatal mortality.

A Century of Germinal Matrix Intraventricular Hemorrhage in Autopsied Premature Infants: A Historical Account

2016 ◽  
Vol 19 (2) ◽  
pp. 108-114 ◽  
Author(s):  
Marco M. Hefti ◽  
Felicia L. Trachtenberg ◽  
Robin L. Haynes ◽  
Catherine Hassett ◽  
Joseph J. Volpe ◽  
...  
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Historical Account ◽  
Germinal Matrix

Retinopathy of Prematurity and other Ocular Problems in Premature Infants Weighing less than 1500 g at Birth

2002 ◽  
Vol 12 (6) ◽  
pp. 506-511 ◽  
Author(s):  
I.C. Asproudis ◽  
S.K. Andronikou ◽  
E.A. Hotoura ◽  
C.D. Kalogeropoulos ◽  
G.K. Kitsos ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Ocular Motility ◽  
Refractive Errors ◽  
Ophthalmological Examination ◽  
Retinal Hemorrhages

Purpose To estimate the incidence of retinopathy of prematurity and other ocular problems in a population of preterm infants. Methods This retrospective study included all infants with gestational age (GA) <32 weeks and birth weight (BW) <1500 g cared for in the neonatal intensive care unit (NICU) over a period of nine years (1992–2000). Ophthalmological examination was started the 4th week of life and included refractive examination, examination of the cornea and funduscopy under mydriasis. An ocular motility test was done after the 2nd month. Results The study included 194 infants. Stage I and II retinopathy occurred in 51 infants but regressed spontaneously. Five of the 194 (2.5%) had to undergo cryopexy. Optic disc atrophy was observed in association with peri-intraventricular hemorrhage (PIIVH) (grade IV) in seven infants. Fifteen infants (7.7%) had retinal hemorrhages which were absorbed by three months of age. Almost 20% of the study infants developed high refractive errors and 13.4% strabismus. Conclusions Not only retinopathy of prematurity, but other serious ocular problems were observed in this population of preterm infants. The role of PIIVH III-IV in the pathogenesis of certain ocular problems needs further elucidation.

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