Prognosis
In infants, germinal matrix haemorrhage is associated with cerebral palsy, problems with cognition, and hydrocephalus. With improved technological advances in science and medicine, survival for preterm infants with this type of neurological disorder has improved and less preterm infants with germinal matrix haemorrhage have severe cerebral palsy. An estimated 15% of preterm infants who survive develop cerebral palsy and 27% of the infants who survive experience moderate to severe neurosensory deficits by the time they reach 18–24 months old.Prognosis is very poor when IVH results from intracerebral hemorrhage related to high blood pressure and is even worse when hydrocephalus follows. It can result in dangerous increases in ICP and can cause potentially fatal brain herniation. Even independently, IVH can cause morbidity and mortality. First, intraventricular blood can lead to a clot in the CSF conduits blocking its flow and leading to obstructive hydrocephalus which may quickly result in increased intracranial pressure and death. Second, the breakdown products from the blood clot may generate an inflammatory response that damages the arachnoid granulations, inhibiting the regular reabsorption of CSF and resulting in permanent communicating hydrocephalus. Associated conditions
Brain contusions and subarachnoid hemorrhages are commonly associated with IVH. The bleeding can involve the anterior communicating artery or the posterior communicating artery. In both adults and infants, IVH can cause dangerous increases in ICP, damage to the brain tissue, and hydrocephalus. Epidemiology
IVH has been reported to occur in approximately 25% of infants who are born with a very low birth weight.
However, it is particularly common in premature infants or those of very low birth weight. The cause of IVH in premature infants, unlike that in older infants, children or adults, is rarely due to trauma. Instead it is thought to result from changes in perfusion of the delicate cellular structures that are present in the growing brain, augmented by the immaturity of the cerebral circulatory system, which is especially vulnerable to hypoxic ischemic encephalopathy. The lack of blood flow results in cell death and subsequent breakdown of the blood vessel walls, leading to bleeding. While this bleeding can result in further injury, it is itself a marker for injury that has already occurred. Most intraventricular hemorrhages occur in the first 72 hours after birth. The risk is increased with use of extracorporeal membrane oxygenation in preterm infants. Congenital cytomegalovirus infection can be an important cause. Mechanism
Diagnosis
Diagnosis can be confirmed by the presence of blood inside the ventricles on CT. Infants
In term and preterm infants with IVH, the amount of bleeding varies. IVH is often described in four grades:
Grade I - bleeding occurs just in the germinal matrix
Grade II - bleeding also occurs inside the ventricles, but they are not enlarged
Grade III - ventricles are enlarged by the accumulated blood
Grade IV - bleeding extends into the brain tissue around the ventriclesGrades I and II are most common, and often there are no further complications. Grades III and IV are the most serious and may result in long-term brain injury to the infant.