Intraventricular haemorrhage (N)

Question 1

Where is IVH common?

Answer 1

germinal matrix above the caudate nucleus

Most in 72hrs of life

Question 2

What are some risk factors for IVH?

Answer 2

• Prematurity
• LBW (occur in 20% of VLBW infants)
• Perinatal asphyxia
• Severe RDS (antenatal GC reduces RDS and therefore IVH)
• Pneumothorax
• Sepsis
• Hypotension/ hypertension

Question 3

What are the signs and symptoms of IVH?

Answer 3

• Can be absent of signs
• Premature infants 🡪 have sudden deterioration with apnoea/ pallor/ cyanosis/ failure to suck/ abnormal eye signs/ shrill cry/ twitching or convulsions/ reduced muscle tone
• Absent moro reflex
• Poor muscle tone
• Lethargy
• Apnoea
• Hemiplegia
• Tense fontanelle

Question 4

What investigations are carried out for IVH?

Answer 4

• ABG 🡪 metabolic acidosis
• FBC 🡪 reduced Hb (doesn’t improve with transfusion)
• Cranial USS 🡪 all babies <30 weeks have USS at 7-14 days age through fontanelle
• MRI 🡪 brain injury and hence consequences for development

Question 5

What is the management for IVH?

Answer 5

Antenatal
- GC’s reduce RDS, low dose indomethacin to infant

Perinatal
- Vitamin K. Avoid birth trauma in delivery

Supportive

• Correct anaemia, acidosis, BP 🡪 packed RBC, FFP, sodium bicarbonate
• Anticonvulsants for seizures
• Acetazolamide reduces CSF production +/- shunts 🡪 less risk of hydrocephalus

Question 6

What are some complications of IVH?

Answer 6

• Seizures
• Developmental delay
• Block in CSF drainage 🡪 hydrocephalus, may need VP shunt but initially relieve with LP or ventricular tap
• Cerebral palsy
• Periventricular white matter injury