Intracranial hemorrhage

Abstract

Germinal matrix/peri-intraventricular hemorrhage (GMH-IVH) is one of the major morbidities in the neonatal intensive care unit (NICU) and may lead to significant long-term neurodevelopmental outcome. The rate and severity are inversely proportional to the gestational age and birth weight, and it is directly related to the immature cerebral structures specially on cellular and vascular proliferation zones of the brain, like germinal matrix. Several other factors are implicated on the genesis of IVH like perinatal asphyxia, resuscitation, hypotension, autoregulation of cerebral blood flow, coagulation, and genetic factors. However, most GMH-IVH are asymptomatic and diagnosis is by ultrasound. Severe hemorrhages (Grade III and IV) are associated with clinical signs and symptoms. Antenatal steroids have the best evidence for prevention of IVH. Outcomes are related to the severity of the initial injury. Periventricular leukomalacia is the most common cause of cerebral palsy in premature newborns and cause serious and permanent consequences.