IVH Interactive Infographic

Intraventicular Hemorrhage

Risk Factors

Incidence

Timing

Diagnosis

Staging

Presentation Classes

Volpe’s classification

Prognosis

Pathogenesis

Causes

Prognosis

GradeI+II• Similar to infants with no IVH• Increased risk for learning problemsGrade III• 40% have major disabilities• 50% have school difficulties

Grade IV

• Mortality is 40%
• 75% risk of neurologic impairment
• CP
• Low cognitive scores • Seizures• Visual disturbances

Diagnosis

Clinical

• Decreased hematocrit
• Bulging fontanel
• Change in level of consciousness

Ultrasound

Subependymal Germinal Matrix

Most common area of origination Beneath the ventricular wallProduces glial cells and neurons Most prominent between 24-32 weeks Primitive and highly vascular Vessels are immature Lack muscle and collagen Susceptible to injury

Germinal Matrix Hemorrhage

} Bleeding into germinal matrix} Hematoma forms } Blood is released into ventricular system if the hematoma ruptures

Volpe’s classification

• Grade I – Bleeding into the germinal matrix • Grade II – Blood fills less than 50% of the ventricle • Grade III – Blood fills over 50% of the ventricle • Grade – IV Hemorrhagic necrosis of the periventricular white matter

Periventricular/ Intraventricular Hemorrhage

Most common in the first 12 hours • 50% by 24 hours • 90% by 72 hours

Risk Factors for IVH

• Prematurity • Respiratory distress • Pneumothorax • Asphyxia • Seizures • Apnea • Manipulation (tracheal suctioning, positioning, handling) • Rapid infusion of IV fluids/colloids • Clotting disorders

Pathogenesis of IVH

• Increased venous pressure impedes cerebral venous return causing venous congestion
• Heart failure, PPV, high CPAP, labor and delivery
• Excess fibrinolytic activity
• Platelet and coagulation disturbances Inflammatory cytokines

• Fluctuating cerebral blood flow
• Lack of autoregulation
• Pressure-passive cerebral circulation

• Related to prematurity, asphyxia, hypoxia, hypercapnia
• Arterial hypotension
• Ischemia, injury and subsequent rupture of capillary walls

Clinical Presenation Classes

Catastrophic • Acute presentation • Rapid and severe • Neurologic and systemic deterioration • High mortality Salutatory • Evolves over hours to days • Changes in neurologic status Silent (50%) • No overt deterioration