IVH

Question 1

What is IVH?

Answer 1

Intracranial hemorrhage arising in germinal matrix (highly vascular
network) + periventricular regions of the brain in preterm infants.

• Germinal matrix matures + becomes smaller with gestational age

Question 2

Risk factors for IVH

Answer 2

Largely changes in hemodynamic status/blood volume

• PDA
• RDS
• pneumothorax
• hypoxia
• Hypercapnia/acidosis
• prematurity birth asphyxia

Question 3

In IVH, what is the cause of brain bleeding?

Answer 3

Fragile blood vessels in matrix that cannot regulate cerebral blood flow.

• Anything really could cause burst and blood to pool in the ventricles = enlargement of ventricles + compression of parenchyma

Question 4

Clinical assessments or lab findings for IVH?

Answer 4

Depends on severity. True neuro irritability and the following could be expected

• Bulging fontanels
• decrease hematocrit
• apnea and/or seizures
• hypotension or hypotonia
• bradycardia
• Acidosis

Question 5

IVH Management

Answer 5

Avoid risk factors (best treatment), if they occur, treatments are usually supportive (refer to IVH protocol)

• maintain CPP via shunts/lumbar punctures to drain excess
• suppress seizures
• manage respiratory status and stabilize hemodynamic status