eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Periventricular Hemorrhage-Intraventricular Hemorrhage: Differential Diagnoses & Workup

Author: David J Annibale, MD, Associate Professor, Director of Neonatology, Director of Fellowship Training Program in Neonatal-Perinatal Medicine, 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
Contributor Information and Disclosures

Updated: Nov 25, 2008

Differential Diagnoses

Apnea of Prematurity
Hypermagnesemia
Hypoglycemia
Neonatal Sepsis
Periventricular Leukomalacia

Workup

Imaging Studies

The following studies are indicated in patients at risk for periventricular hemorrhage–intraventricular hemorrhage (PVH-IVH) and those who have PVH-IVH:

  • Cranial ultrasonography
    • Ultrasonography is the diagnostic tool of choice for screening examination and follow-up of individuals with PVH-IVH. Current recommendations by the Quality Standards Subcommittee of the American Academy of Neurology suggest that all infants younger than 30 weeks' gestation be screened by cranial ultrasonography at 7-14 days postnatal life and at 36-40 weeks postmenstrual age.13
    • Ultrasonography is also the diagnostic tool of choice for the follow-up of individuals with PVH-IVH and posthemorrhagic hydrocephalus. Serial ultrasonography is indicated weekly to follow for progression of hemorrhage and the development of posthemorrhagic hydrocephalus.
  • CT scan
    • Prior to the availability of ultrasonography, CT scanning was used for diagnosis and follow-up.
    • CT scanning is no longer used for diagnosis and follow-up in view of the safety and cost effectiveness of sonography.
  • MRI: The use of MRI to diagnose associated white mater injury (periventricular leukomalacia [PVL] is evolving.

Other Tests

  • Although not as useful as ultrasonography, frontal-occipital circumference can be used as an adjunct tool in monitoring the progression of posthemorrhagic hydrocephalus.

More on Periventricular Hemorrhage-Intraventricular Hemorrhage

Overview: Periventricular Hemorrhage-Intraventricular Hemorrhage
Differential Diagnoses & Workup: Periventricular Hemorrhage-Intraventricular Hemorrhage
Treatment & Medication: Periventricular Hemorrhage-Intraventricular Hemorrhage
Follow-up: Periventricular Hemorrhage-Intraventricular Hemorrhage
Multimedia: Periventricular Hemorrhage-Intraventricular Hemorrhage
References
[ CLOSE WINDOW ]

References

  1. Perlman JM, McMenamin JB, Volpe JJ. Fluctuating cerebral blood-flow velocity in respiratory-distress syndrome. Relation to the development of intraventricular hemorrhage. N Engl J Med. Jul 28 1983;309(4):204-9. [Medline].

  2. Perlman JM, Volpe JJ. Prevention of neonatal intraventricular hemorrhage. Clin Neuropharmacol. Apr 1987;10(2):126-42. [Medline].

  3. Perlman J, Thach B. Respiratory origin of fluctuations in arterial blood pressure in premature infants with respiratory distress syndrome. Pediatrics. Mar 1988;81(3):399-403. [Medline].

  4. Perlman JM, Goodman S, Kreusser KL, Volpe JJ. Reduction in intraventricular hemorrhage by elimination of fluctuating cerebral blood-flow velocity in preterm infants with respiratory distress syndrome. N Engl J Med. May 23 1985;312(21):1353-7. [Medline].

  5. Volpe JJ. Intracranial hemorrhage: Germinal matrix hemorrhage. In: Neurology of the Newborn. 5th. Philadelphia, PA: Saunders Elsevier; 2008:403-463.

  6. Hammerman C, Glaser J, Schimmel MS, et al. Continuous versus multiple rapid infusions of indomethacin: effects on cerebral blood flow velocity. Pediatrics. Feb 1995;95(2):244-8. [Medline].

  7. van Bel F, Klautz RJ, Steendijk P, et al. The influence of indomethacin on the autoregulatory ability of the cerebral vascular bed in the newborn lamb. Pediatr Res. Aug 1993;34(2):178-81. [Medline].

  8. Ment LR, Vohr B, Oh W, et al. Neurodevelopmental outcome at 36 months'' corrected age of preterm infants in the Multicenter Indomethacin Intraventricular Hemorrhage Prevention Trial. Pediatrics. Oct 1996;98(4 Pt 1):714-8. [Medline].

  9. Ment LR, Oh W, Ehrenkranz RA, et al. Low-dose indomethacin and prevention of intraventricular hemorrhage: a multicenter randomized trial. Pediatrics. Apr 1994;93(4):543-50. [Medline].

  10. Ment LR, Vohr BR, Makuch RW, et al. Prevention of intraventricular hemorrhage by indomethacin in male preterm infants. J Pediatr. 2004;145:832-4. [Medline].

  11. Ment LR, Peterson BS, Meltzer JA, et al. A functional magnetic resonance imaging study of the long-term influences of early indomethacin exposure on language processing in the brains of prematurely born children. Pediatrics. Sep 2006;118(3):961-70. [Medline].

  12. Ohlsson A, Roberts RS, Schmidt B, et al. Male/female differences in indomethacin effects in preterm infants. J Pediatr. Dec 2005;147(6):860-2. [Medline].

  13. Ment LR, Bada HS, Barnes P, et al. Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;25:1726-38. [Medline].

  14. Schmidt B, Davis P, Moddemann D, et al. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med. Jun 28 2001;344(26):1966-72. [Medline].

  15. Maher P, Lane B, Ballard R, et al. Does indomethacin cause extension of intracranial hemorrhages: a preliminary study. Pediatrics. Mar 1985;75(3):497-500. [Medline].

  16. Bada HS, Korones SB, Perry EH, et al. Frequent handling in the neonatal intensive care unit and intraventricular hemorrhage. J Pediatr. Jul 1990;117(1 Pt 1):126-31. [Medline].

  17. Bada HS, Korones SB, Perry EH, et al. Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage. J Pediatr. Oct 1990;117(4):607-14. [Medline].

  18. Barnes ER, Thompson DF. Antenatal phenobarbital to prevent or minimize intraventricular hemorrhage in the low-birthweight neonate. Ann Pharmacother. Jan 1993;27(1):49-52. [Medline].

  19. Boynton BR, Boynton CA, Merritt TA, et al. Ventriculoperitoneal shunts in low birth weight infants with intracranial hemorrhage: neurodevelopmental outcome. Neurosurgery. Feb 1986;18(2):141-5. [Medline].

  20. Busija DW, Heistad DD. Effects of indomethacin on cerebral blood flow during hypercapnia in cats. Am J Physiol. Apr 1983;244(4):H519-24. [Medline].

  21. Fanaroff AA, Martin RJ. The central nervous system: Intracranial hemorrhage. In: Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 1997:891-3.

  22. Fanconi S, Duc G. Intratracheal suctioning in sick preterm infants: prevention of intracranial hypertension and cerebral hypoperfusion by muscle paralysis. Pediatrics. Apr 1987;79(4):538-43. [Medline].

  23. Garland JS, Buck R, Leviton A. Effect of maternal glucocorticoid exposure on risk of severe intraventricular hemorrhage in surfactant-treated preterm infants. J Pediatr. Feb 1995;126(2):272-9. [Medline].

  24. Goddard-Finegold J, Armstrong D, Zeller RS. Intraventricular hemorrhage, following volume expansion after hypovolemic hypotension in the newborn beagle. J Pediatr. May 1982;100(5):796-9. [Medline].

  25. Krishnamoorthy KS, Kuban KC, Leviton A, et al. Periventricular-intraventricular hemorrhage, sonographic localization, phenobarbital, and motor abnormalities in low birth weight infants. Pediatrics. Jun 1990;85(6):1027-33. [Medline].

  26. Leffler CW, Busija DW, Beasley DG. Effect of therapeutic dose of indomethacin on the cerebral circulation of newborn pigs. Pediatr Res. Feb 1987;21(2):188-92. [Medline].

  27. Mardoum R, Bejar R, Merritt TA, Berry C. Controlled study of the effects of indomethacin on cerebral blood flow velocities in newborn infants. J Pediatr. Jan 1991;118(1):112-5. [Medline].

  28. McLendon D, Check J, Carteaux P, et al. Implementation of potentially better practices for the prevention of brain hemorrhage and ischemic brain injury in very low birth weight infants. Pediatrics. Apr 2003;111(4 Pt 2):e497-503. [Medline].

  29. Ment LR, Ehrenkranz RA, Duncan CC. Intraventricular hemorrhage of the preterm neonate: prevention studies. Semin Perinatol. Oct 1988;12(4):359-72. [Medline].

  30. Ment LR, Oh W, Ehrenkranz RA, et al. Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants. Am J Obstet Gynecol. Mar 1995;172(3):795-800. [Medline].

  31. Ment LR, Stewart WB, Ardito TA, et al. Indomethacin promotes germinal matrix microvessel maturation in the newborn beagle pup. Stroke. Aug 1992;23(8):1132-7. [Medline].

  32. Ment LR, Vohr B, Allan W, et al. Outcome of children in the indomethacin intraventricular hemorrhage prevention trial. Pediatrics. Mar 2000;105(3 Pt 1):485-91. [Medline]. [Full Text].

  33. Roberts JR. Drug therapy in infants. In: Pharmacologic Principles and Clinical Experience. 1984:229-3, 261-9.

  34. Thomas SJ, Morgan MA, Asrat T, Weeks JW. The risk of periventricular-intraventricular hemorrhage with vacuum extraction of neonates weighing 2000 grams or less. J Perinatol. Jan-Feb 1997;17(1):37-41. [Medline].

  35. Ventriculomegaly Trial Group. Randomized trial of early tapping in neonatal posthemorrhagic ventricular dilatation. Arch Dis Child. Jan 1990;65(1 Spec No):3-10. [Medline].

  36. Whitaker AH, Feldman JF, Van Rossem R, et al. Neonatal cranial ultrasound abnormalities in low birth weight infants: relation to cognitive outcomes at six years of age. Pediatrics. Oct 1996;98(4 Pt 1):719-29. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

periventricular hemorrhage, PVH, intraventricular hemorrhage, IVH, germinal matrix hemorrhage, intraventricular hemorrhage, periventricular hemorrhage, cerebral palsy, developmental delay, hypocarbia, hypercarbia, hypoxemia, acidosis, hydrocephalus, ventricular-peritoneal shunt, mental retardation, seizures, obstructive hydrocephalus, global hypoxic-ischemic injury, periventricular leukomalacia, PVL, nonhemorrhagic ischemic necrosis, anemia, metabolic acidosis, glucose instability, respiratory acidosis, apnea, hypotonia, hypercarbia, hypocarbia pneumothorax, hypoxemia

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

David J Annibale, MD, Associate Professor, Director of Neonatology, Director of Fellowship Training Program in Neonatal-Perinatal Medicine, Department of 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
Disclosure: Nothing to disclose.

Coauthor(s)

Jeanne Hill, MD, Radiology Program Director, Associate Professor, Departments of Radiology and Pediatrics, Medical University of South Carolina
Jeanne Hill, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, Association of Program Directors in Radiology, Association of University Radiologists, Radiological Society of North America, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Medical Editor

Scott MacGilvray, MD, Clinical Associate Professor of Pediatrics, East Carolina University School of Medicine
Scott MacGilvray, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: MedImmune Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Brian S Carter, MD, FAAP, Professor of Pediatrics (Neonatology), Vanderbilt University School of Medicine; Co-director, Pediatric Advance Comfort Team, Monroe Carell Jr Children's Hospital at Vanderbilt
Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, National Hospice and Palliative Care Organization, and National Perinatal Association
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD, Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.