IVH in Preterm Infants

Sue Ann Smith

Preterm Neonates - IVH

• Gestation usually less than 32 weeks, but may occur in more mature preterm infants

• May rarely occur in the term neonate

• The primary site of hemorrhage is the germinal matrix.

• A secondary site is the choroid plexus - especially in the more mature infant

IVH timing

• Set up for IVH usually present at birth

• Bleeding usually not present before 24 hours, 75% of all IVH seen by 72 hours, and > 95% by 1 week of age.

• Risk of new IVH after 1 weeks is very low.

• Still need to follow for PVL, which is not usually detectable for 4-6 weeks by US.

Grading IVH by Ultrasound

• Grade I - Germinal matrix hemorrhage (GMH) without extension into the ventricle

• Grade II - GMH with extension of blood into ventricle, but without distension of ventricle.

• Grade III - GMH with distension of ventricle.

Intraparenchymal hemorrhage• Intraparenchymal ischemia/hemorrhage in

periventricular area (sometimes called Grade IV IVH)

• Periventricular ischemia – may lead to hemorrhagic infarct – or to non-hemorrhagic infarct

• Areas of infarct become necrotic and are “cleaned up” to become holes

– periventricular leukomalacia (PVL)

– porencephalic cyst(s)

Normal Cranial Ultrasound

Abnormal Cranial Ultrasounds

Cranial Ultrasound with Parenchymal Hemorrhage

Coronal and sagittal views of intraparenchymal hemorrhage

PVL