Anemia of Prematurity - Portal Neonatal

Periventricular Hemorrhage-Intraventricular
Hemorrhage
Last Updated: May 14, 2003
Synonyms and related keywords: PVH, IVH, germinal matrix hemorrhage, intraventricular
hemorrhage, periventricular hemorrhage
AUTHOR INFORMATION Section 1 of 11
Author: David J Annibale, MD, Director of Fellowship Training Program in Neonatal-Perinatal
Medicine, Associate Professor, Department of Pediatrics, Medical University of South Carolina
Coauthor(s): Jeanne Hill, MD, Radiology Program Director, Associate Professor, Departments of
Radiology and Pediatrics, Medical University of South Carolina
David J Annibale, MD, is a member of the following medical societies: American Academy of
Pediatrics, and National Perinatal Association
Editor(s): Scott MacGilvray, MD, Associate Professor, Department of Pediatrics, Pitt County
Memorial Hospital; Robert Konop, PharmD, Director, Clinical Account Management, Ancillary
Care Management; Brian S Carter, MD, Associate Director, Associate Professor, Department of
Pediatrics, Division of Neonatology, Vanderbilt University Medical Center and Gateway Medical
Center; Carol L Wagner, MD, Associate Professor, Department of Pediatrics, Division of
Neonatology, Medical University of South Carolina; and Neil N Finer, MD, Director, Division of
Neonatology, Professor, Department of Pediatrics, University of California at San Diego
INTRODUCTION Section 2 of 11
Background: Families and caregivers of preterm infants and those threatened with preterm delivery
must face 2 major unknowns regarding these newborns: Will this child survive? If the child survives,
will this child be brain damaged? These questions are of particular importance because the answers
can influence subsequent medical decisions, such as aggressiveness of care. Several acquired
lesions of the central nervous system (CNS) specifically affect infants born prematurely and result in
long-term disability. This chapter reviews one of the important CNS lesions, periventricular
hemorrhage-intraventricular hemorrhage (PVH-IVH), which involves the periventricular white matter
(motor tracts) and is associated with long-term disability.
PVH-IVH remains a significant cause of both morbidity and mortality in infants who are born
prematurely. Sequelae of PVH-IVH include life-long neurological deficits, such as cerebral palsy,
mental retardation, and seizures. PVH-IVH is diagnosed primarily through the use of brain imaging
studies, usually cranial ultrasonography. As PVH-IVH can occur without clinical signs, serial
examinations are necessary for the diagnosis.
Although classified according to anatomic involvement by Papile, a modified classification has
recently emerged based on the pathophysiological processes that result in hemorrhage. Recent
advances also have presented options for the prevention of such events. Still, PVH-IVH remains a
serious problem, despite recent decreases in incidence, due to increased survival of extremely low
birthweight infants (ie,