Makindo Medical Notes

🧠 Intraventricular haemorrhage (IVH) is the most common type of intracranial haemorrhage in the neonate. It occurs primarily in preterm infants 👶 but can occasionally be seen in near-term and term babies.

📖 About

• Bleeding into the brain’s ventricles.
• Severe cases → neuronal damage and long-term brain injury 🧩.

⚙️ Aetiology

• Most common in premature babies ⏳.
• Overall incidence is falling 📉 with modern neonatal care.
• Pathogenesis: hypoxic–ischaemic reperfusion injury of the germinal matrix.

⚠️ Higher Risk Groups

• Prematurity ⏳ and very-low-birth-weight infants (<1500 g / <3 lb 5 oz)
• Respiratory distress (e.g. hyaline membrane disease) 🫁
• Complications of prematurity, labour/delivery trauma
• Maternal infection 🤰🦠, hypertension, clotting disorders
• Head injury/shaken baby 🚨
• Genetic predisposition

🔎 Clinical Features

• Apnoea, bradycardia, cyanosis 💙, poor suck
• High-pitched cry, lethargy, stupor, or coma 🛌
• Bulging/tense fontanelle 🔺
• Hypotonia, weak reflexes, seizures ⚡, decerebrate posturing
• Abnormal eye movements 👀

🧪 Investigations

• FBC: often shows anaemia 📉
• Cranial ultrasound = diagnostic test of choice 🖥️

📊 Severity (Grading)

• Grade I: Germinal matrix only
• Grade II: Blood in ventricles
• Grade III: Ventricular dilatation
• Grade IV: Extension into parenchyma

☠️ Grades & Mortality

• Grade I: ~6% mortality
• Grade II: ~33% mortality
• Grade III: ~60% mortality
• Grade IV: ~93% mortality

💡 Exam Tip: Grade IV bleeds often cause venous infarction due to medullary venous obstruction → secondary haemorrhage. High-yield for finals ⚡.

🩺 Management

• Prevention: Antenatal steroids (24–34 wks) reduce risk 📉.
• Screening: Premature <32 wks → routine cranial US.
• Treatment: Supportive care, ICP monitoring where indicated.
• Grades I–II: Often no long-term complications 🙂.
• Grades III–IV: Risk of hydrocephalus, neurodevelopmental delay, ↑ mortality 🚨.

📚 References

• RPA Newborn Care Guidelines