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SEARCH RESULTS FOR: intraventricular-hemorrhage-in-preterm-infants-clinical-findings-and-complications

intraventricular-hemorrhage-in-preterm-infants-clinical-findings-and-complications

Intraventricular hemorrhage (IVH) in preterm infants: Clinical findings and complications Authors: Alexa Scarcello Reviewers: Nicola Adderley, Emily Ryznar, Yan Yu*, Jennifer Unrau* * MD at time of publication Volpe Grading Grade I: germinal matrix hemorrhage with no or minimal IVH (<10% of ventricular area) Grade II: IVH (10-50% of ventricle) Grade III: IVH (>50% of ventricle; usually distends lateral ventricle) Grade IV/Intra-parenchymal echodensity (IPE): periventricular hemorrhagic infarction Inflammation/dysfunction of arachnoid villi ↓ absorption of CSF 2° to obstruction of arachnoid villi Communicating hydrocephalus (IVH grades II-IV) Venous congestion Venous infarction Periventricular hemorrhagic necrosis Destruction of periventricular motor tracts Cerebral palsy Rapid significant blood loss ↓ intravascular blood volume Hypotension ↓ bloodflow to the brain to support brain function Intraventricular Hemorrhage (IVH) hemorrhage in periventricular subependymal germinal matrix Ultrasound: blood in germinal matrix, ventricles, or cerebral parenchyma Sudden ↓ hematocrit Blood irritates contiguous structures Variable neurologic findings; including altered level of consciousness, hypotonia, apnea, etc Neuro- developmental abnormalities (varying severity) See slide - Hydrocephalus: Clinical Findings in Pediatrics This mechanism leads to three different possible clinical manifestations: 1. Silent Presentation (most common) 2. Stuttering/Saltatory Course: non-specific findings - hypotonia, apnea, altered level of consciousness, bradycardia, and ↓ Spontaneous movements 3. Catastrophic Deterioration (least common) Stupor or coma, decerebrate posturing, seizures, bradycardia, metabolic acidosis, bulging fontanelles, abnormal pupillary reflexes, inappropriate ADH secretion Notes • Incidence & severity are inversely proportional to gestational age • 50% occur within 1st day of life, 90% by 3rd day • As explained in the flow chart, the postnatal clinical presentations of IVH fall into three categories (1-3) • Symptoms of catastrophic bleeds are uncommon and usually caused by rapid significant blood loss with subsequent neurologic findings 2° to meningeal irritation, inflammation, and potential mass effect/acute hydrocephalus; severe bleeds may also occur in the absence of clinical findings attributable to IVH Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published July 27, 2019 on www.thecalgaryguide.com