Intraventricular hemorrhage and long-term outcome in the premature infant.

Abstract: Intraventricular hemorrhage (IVH) is a common, serious problem among premature infants. With advances in neonatal care, improved survival rates of small premature infants and improved diagnostic capabilities, IVH is seen with increased frequency in the high-risk nursery. Studies indicate

15-20% of premature infants (birth weight less than 1,500 gms), have been noted to hate IVH.[20] Many of these neonates survive beyond infancy and may subsequently be seen in pediatric neurosurgery and neurology clinics with long-term problem such as hydrocephalus, cerebral palsy, mental retardation and seizures. Although long-term sequelae are not always present, it is beneficial for the neuroscience nurse to be able to understand the mechanism of brain injury with IVH in order to anticipate long-term problems and provide comprehensive follow-up care for infants and children with this diagnosis.

Introduction

Intraventricular hemorrhage (IVH) is the most common type of intracranial hemorrhage seen in the neonate. It is important not only because it is frequently seen in the high-risk nursery, but also because it can have serious neurological sequelae. Neurological sequelae are more common with higher grades of IVH. The incidence of IVH is inversely related to an infant's gestational age and birth weight while seventy is related to the concomitant seventy of the infant's respiratory distress.

In the late 1970's IVH was found in 34-49% of all premature births.[20] Although the incidence of IVH has declined in recent years to 15-20% of premature births, the overall incidence of premature birth has increased and survival rates continue to increase, so IVH and its neurological sequelae will continue to be a problem.[20]

This review article discusses the pathology, clinical features, grading, treatment, short and long-term outcomes and nursing implications of IVH. Selected studies from the literature regarding long-term outcome of IVH are also summarized.

Pathology

Ninety percent of all hemorrhages occur between the first and fourth day of the infant's life, while 95% occur by day seven. There are several basic problems leading to the premature infant's predisposition to IVH. The first is the germinal matrix which is the most common area for hemorrhage to occur. This is a richly vascularized structure present in the premature infant in the subependymal region around the lateral ventricle at die level of the foramen of Monro and the head of the caudate nucleus. It is the site of production and early maturation of neuronal and glial precursors. Small, fragile immature vessels run through this jelly-like structure and are susceptible to rupture because of a lack of muscularis layer or support stroma. The vessels in this "capillary bed" do not resemble arterioles or venules and are sometimes classified as channels. They have been described as immature vascular structures turning into a real capillary bed only after the germinal matrix disappears.[20] The germinal matrix is most pronounced at 23-24 weeks gestation. By 28-32 weeks gestation it becomes less prominent so that at term few germinal matrix vessels remain.