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Periventricular Hemorrhage-Intraventricular Hemorrhage Workup

  • Author: David J Annibale, MD; Chief Editor: Ted Rosenkrantz, MD  more...
Updated: Mar 19, 2014

Laboratory Studies

Grade III-IV PVH-IVH has been associated with abnormally high (odds ratio [OR], 1.2.931 [1.825-4.707]) or, to a lesser degree, low (OR, 1.24 [1.036-1.484]) lymphocyte counts,[16] based on reference ranges the authors defined. While nondiagnostic for PVH-IVH, abnormalities might lead to further evaluation.


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.[17]
    • Ultrasonography is also the diagnostic tool of choice for the follow-up of individuals with PVH-IVH and posthemorrhagic hydrocephalus, as shown below. Serial ultrasonography is indicated weekly to follow for progression of hemorrhage and the development of posthemorrhagic hydrocephalus.
      Hydrocephalus. Hydrocephalus.
    • Normal neonatal brain images are shown below.
      Sonographic appearance of a normal neonatal brain.Sonographic appearance of a normal neonatal brain. Image is from a coronal midline scan.
      Normal neonatal brain shown with left sagittal scaNormal neonatal brain shown with left sagittal scan.
      Normal neonatal brain shown with midline sagittal Normal neonatal brain shown with midline sagittal scan.
  • 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

See the list below:

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

David J Annibale, MD Professor of Pediatrics, 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, National Perinatal Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

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 Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Scott S MacGilvray, MD Clinical Professor, Department of Pediatrics, Division of Neonatology, The Brody School of Medicine at East Carolina University

Scott S MacGilvray, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.


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.

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Sonographic appearance of a normal neonatal brain. Image is from a coronal midline scan.
Normal neonatal brain shown with left sagittal scan.
Normal neonatal brain shown with midline sagittal scan.
Grade I hemorrhage minimal or grade I periventricular hemorrhage (PVH).
Moderate or grade II hemorrhage (subependymal with no or little ventricular enlargement).
Severe or grade III hemorrhage (subependymal with significant ventricular enlargement).
Intraventricular hemorrhage (IVH) with periventricular hemorrhagic infarction (PVHI).
Periventricular hemorrhagic infarction (PVHI) with porencephalic cyst formation.
Periventricular hemorrhagic infarction (PVHI) on MRI.
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