AKT · Child health/Neonatal & surgicallow yield

Intraventricular haemorrhage (IVH)

Bleeding from the fragile germinal matrix of the preterm brain

Overview

Bleeding into the germinal matrix/ventricles of the PRETERM brain, from the fragile immature vasculature — commonest in the first few days, especially in the very preterm/unstable infant. Graded I-IV; severe IVH causes post-haemorrhagic hydrocephalus and neurodevelopmental impairment. Detected by cranial ultrasound screening; management is supportive with monitoring for hydrocephalus.

Recognise

Very preterm infant, usually within the first 72 hours; may be silent or present with deterioration, apnoea, seizures, a falling haematocrit, a bulging fontanelle
Graded I-IV (IV = parenchymal involvement); risk factors: extreme prematurity, hypoxia, instability, pneumothorax
Complication: post-haemorrhagic hydrocephalus, neurodevelopmental impairment

Red flags

Post-haemorrhagic ventricular dilatation/hydrocephalus (expanding head, bulging fontanelle) → neurosurgical input
Acute deterioration/seizures

Differentials & how to tell them apart

Other neonatal collapse (sepsis, metabolic)cranial USS identifies IVH

Hypoxic-ischaemic encephalopathyterm infant after birth asphyxia — different mechanism/imaging

Investigations

CRANIAL ULTRASOUND (through the fontanelle — screening and grading); monitor head circumference; coagulation/haematocrit.

Management

Supportive care + cranial USS surveillance; treat post-haemorrhagic hydrocephalus

1Cranial ultrasound screening in preterm infants detects and grades IVH. Supportive intensive care; monitor head circumference for hydrocephalus.Gate: Prevention is about avoiding the precipitants (instability, hypoxia, pneumothorax, rapid fluid/pressure swings); severe IVH → monitor for post-haemorrhagic hydrocephalus needing neurosurgical intervention
2Manage hydrocephalus (reservoir/shunt); neurodevelopmental follow-up.

Supportive neonatal intensive care — maintain stability; there is no specific treatment for the bleed itself

Manage post-haemorrhagic hydrocephalus — tapping/reservoir/shunt as needed

Key points

Very preterm + first few days + deterioration/bulging fontanelle = IVH (germinal matrix) → cranial USS. Watch for post-haemorrhagic hydrocephalus. Prevent by keeping the baby stable.

Monitor & prognosis

Cranial USS, head circumference; development.

Mild grades good; severe IVH impairs neurodevelopment.

Source: RCPCH; BAPM