Intraventricular Hemorrhage Flashcards
What is IVH?
Bleeding in ventricles of the brain. Common in premature infants
What is the biggest risk factor for IVH?
Low gestational age and birth weight
Why does IVH happen?
Weeks 20-36 there is rapid development so brain is fragile. Germinal matrix is a temporary blood supply to brain in utero. GM is at risk for rupture due to physical damage and increased blood flow.
Where do term neonates typically have IVH?
Lateral ventricles
Where do premature infants typically have IVH?
In germinal matrix because of vascularity and fragility
What factors increase blood flow to the brain?
PDA, transfusion, volume expansion, hypercarbia
What factors decrease blood flow to the brain?
Sepsis, hypovolemia, hyperglycemia, and hypocarbia
How is IVH typically diagnosed?
With CT or ultrasound
What are the grades of IVH?
1- limited to germinal matrix
2- germinal bleed with blood in ventricles but no dilation
3- germinal bleed with dilation of ventricles
4- blood in ventricles extends into parenchyma
What are common signs of bleeding in the germinal matrix?
apnea, hypotension, decreased hematocrit, flaccidity, bulging fontanelles, tonic posturing
How do we manage IVH?
Preventing premature delivery, corticosteroids, delayed cord clamping, maintaining neutral head position, monitoring vitals
How can CO2 cause injury to the germinal matrix?
Dropping the CO2 levels will constrict blood flow in the brain, then increasing CO2 will dilate vessels. This large fluctuation can cause damage and make the germinal matrix rupture.
