IVH of Prematurity

FACTS HPI PHYSICAL EXAM IMAGING Grades of IVH Pre-Omaya Protocol Post-Omaya

FACTS

#1 cause of hydrocephalus in preterm infants

Pathophysiology: alterations of cerebral blood flow through germinal matrix can lead to hemorrhage, as these vessels to not have typical components of the BBB. The matrix is a well-vascularized periventricular sub-ependymal area of the brain.

Origin of bleeds

PREMATURE babies IVH --> germinal matrix

TERM babies IVH --> choroid plexus

HPI

Common co-morbidities: apnea of prematurity, respiratory distress w/ ventilator dependence, anemia, E faecalis sepsis, PDA

Check for bradycardia / desaturations and ask NICU nurses

check weight (cannot operate on a human being < 2kg)

PHYSICAL EXAM

check fontanelles
evaluate for dilated scalp veins

evaluate for sun-setting of pupils (forced downgaze)

if severe: transillumination of cranium
evaluate symmetry of spontaneous movements (hemorrhage may cause contralateral hemiparesis)

IMAGING

US is best modality, no transport, no radition

MRI is okay modality of child is safe to transport

CT least desirable, involves transport and radiation

evalute for periventricular leukomalacia

A/P

daily OFCs

serial lumbar taps (pediatricians/neonatologists)

serial US

serial OFCs (use corrected age!)

CSF diversion:

Ventriculoperitoneal Shunts

Ventriculo-subgalael shunts

Ommaya

ETV (low success score)

NICU protocol

(pre Omaya): LP taps per NICU protocol

(post Omaya): Omaya taps per NICU protocol

Grades of IVH

Grade	Blood burden	Ventriculomegaly / Hydro
1	confined to germinal matrix	none
2	blood in ventricles	none, although may go on to develop hydro
3	blood in ventricles	yes
4	blood in ventricles + ruptures/dissection of clot into surrounding white matter	yes