Interventricular Hemorrhage (IVH)

Question 1

Grade I

Answer 1

isolated germinal matrix hemorrhage

Question 2

Grade II

Answer 2

normal sized ventricles that occurs when hemorrhage isn the subependymal matrix ruptures through the ependyma into the lateral ventricles

Question 3

Grade III

Answer 3

acute ventricular dilation

Question 4

Grace IV

Answer 4

hemorrhage into periventricular white matter

Question 5

IVH

Answer 5

occurs in neonates younger than 32 wks and weighing less than 1500g
most hemorrhages occur w/in first 24hrs after birth and progress over 48 hrs or more, by end of first 24hrs after birth hemorrhage has reached its full extent

Grade is determined by cranial ultrasound imaging
–required to be completed on all neonates less than 30 weeks

Subependymal germinal matrix = gelatinous area that contains a rich vascular supply network, prominent from 26-34 weeks and is usually gone by term

hypoxia and hypoxemia in neonate interfere with cerebral autoregulation and increase the risk of vessel rupture

Question 6

Perinatal events leading to increased cerebral blood flow and IVH

Answer 6

RDS, apnea, hypotension, rapid volume expansion, routine caregiving interventions, environmental stress such as noise and light

Question 7

S/S of IVH

Answer 7

range mild to severe

clinical signs: decreased hematocrit, full anterior fontanelle, changes in activity level, impaired visual tracking, increased mm tone of lower limbs, neck flexor hypotonia, brisk tendon reflexes

Catastrophic deterioration of major hemorrhages– stupor with progression to coma, RDS progressing to apnea, generalized tonic seizures, decerebrate posturing, fixation of pupils to light and flaccid quadriparesis

Question 8

Treatment of IVH

Answer 8

acute treatment, pharmacologic intervention, and mgmt of ventricular dilation (shunting, etc.)

acute treatment- physiologic support to maintain oxygenation, perfusion, body temperature, and blood glucose levels, minimize handling
– should position child in prone of side lying with head in midline or to the side without flexion

Question 9

Outcomes of IVH

Answer 9

depend of severity and extent of hemorrhage and presence of associated problems

small or mild hemorrhage = survive with low incidence of complications
moderate = mortality rate of 5-20%, ventricular dilation develops in 15-20%
Severe = mortality rate of 50%, increased incidence of neuro conditions such as CP, hydrocephalus, cognitive impairment, sensory and attention problems, learning disorders,