IVH is the most common CNS complication

The more premature, the higher incidence of IVH

IVH diagnosis
By cranial ultrasound
Done at 3-7 dyas of life
Repeat at 1 month for ventricular dilation/ PVL
Repeat at 36-40 weeks PMA
A normal USG cranium does not exclude injury nor imply nomral outcome

IVH use Papile grading

Grade 1 and 2 mild IVH
Grade 3 and 4 moderate IVH
Grade 1 is germinal matrix haemorrhage
Grade 2 is IVH without distending ventricle
Grade 3 is IVH with enough blood to distend ventricle
Grade 4 is bleed in parenchyma, not IVH

Presentation
Silent - most common
Full fontanelle
Decreasing Hct/ anaemia

Saltatory
hypotonia, change in consciousness

Caatastrophic
Apnoea
Stupor

Management of IVH
Maintain cerebral perfusion. blood pressure, electrolytes
Treat causes

Complications
Can develop post haemorrhagic ventriculomegaly, then hydrocephaly
1/3 of IVH will develop post haemorrhagic ventriculomegaly

Monitoring
Clinical features - vital signs, feeding intolerance, lethargy, apnoea, bradycardia
Serial measurement - OFC
Serial US cranium - to measure ventricular index

Management of post haemorrhagic ventriculomegaly

1. Medications
1. Decrease CSF production - no longer option for treatment
1. Acetozolamide
2. Frusemide
 2. Promote fibrinolysis - increased risk of haemorrhage, no longer option of
treatment
1. IV streptokinase
2. rTPA
2. Lumbar puncture with Ommya reservoir
3. VP shunt
1. Permanent drainage
2. Complications include infection, obstruction

Risk factors for poor prognosis

Parenchymal involvement
PVL
Low gestational age
Grading

PVL depends on site and size of lesion

Unilateral involvement - unilateral spastic CP
Bilateral involvement - bilateral spastic CP

Antenatal glucocorticoids significantly reduces risk of IVH

Intrapartum interventions - transport to tertiary centre, resus team, maintain neutral thermal
environment, avoid head down positions, DCC
Neuroprotective care

 Appropriate respriatory support

o maintenance of normal CO2 level
o Use synchronised ventilation, asynchrony can cause fluctuation in cerebral
blood flow
 Avoid rapid IV flush
o e.g. UAC/ UVC flushing
 Midline head positioning
o Elevate head 30 degrees for first 72 hours of life in < 32w gestation to prevent
alterations in blood flow
 Minimal handling
 Suction only when required

Postnatal pharmacotherapy
No long term benefits of indomethacin
There are signicifant side effects for indomethacin