Chapter 19: Intraventricular Hemorrhage (Newborn)

Question 1

Intraventricular Hemorrhage

Answer 1

hemorrhages, which are bleeding into the epidural, subdural, or subarachnoid area of the brain
-most occur within the first 72 hours of life
>can be minimal or extensive and present clinically asymptomatic to seizure activity, depending on stage of involvement
-can be attributed to rapid volume expansion in preterm newborns
-also in low-birth-weight newborns

Question 2

Signs and Symptoms

Answer 2

can be asymptomatic

• decreased tone or change in activity level
• seizures
• sudden drop in hematocrit
• full anterior fontanelle

Question 3

Classifications

Answer 3

• Grade I: hemorrhages bleed into the subependyma only
• Grade II: hemorrhages bleed into the subependyma, and the ventricles but do not produce distention of ventricles
• Grade III: hemorrhages bleed into the ventricles and produce dilation of the ventricles that can lead to hydrocephalus
• Grade IV: hemorrhages produce the same bleeding as in grade III, but the bleeding extends to the parenchyma

Question 4

Diagnosis

Answer 4

• by cerebral ultrasound and follow up with magnetic imaging or computed tomography scan
• can also be made by observing behavioral changes and altered states of consciousness in the preterm newborn
• an enlarging head circumference needs immediate attention and indicative of worsening IVH

Question 5

Prevention

Answer 5

• treatment of respiratory distress syndrome and resuscitation by a neonatal team proficient in caring for low-birth-weight newborns
• provide neutral thermal environment

Question 6

Nursing Care

Answer 6

• monitors behavior and assesses head circumference and fontanelles (make sure they are soft, flat, and open on palpation)
• decrease intracranial pressure by placing newborn in supine position at a 30 degree angle
• recognizing of newborn seizures (priority)
• observe for neurological symptoms, including poor oxygenation readings on pulse oximeter, poor feeding, and lethargic behavior

Question 7

Medications

Answer 7

• medications are given to prevent and treat seizure activity that accompanies IVH
• phenobarbital (Luminal Sodium drug of choice) and phenytoin (Dilantin) are prescribed to prevent seizure activity and considered maintenance medications
• Diazepam (Valium) and Lorazepam (Ativan) are often given to stop seizure activity and are emergency medications