Intraventricular Hemorrhage in the Preterm Infant Clinical Presentation

Updated: Jul 24, 2018
  • Author: David J Annibale, MD; Chief Editor: Santina A Zanelli, MD  more...
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Presentation

History

Loss of autoregulation of cerebral blood flow is a pathophysiologic feature of germinal matrix/intraventricular hemorrhage (GM/IVH). Prematurity itself results in derangements in cerebral autoregulation. In some patients, a history of additional events that result in loss of autoregulation can be obtained. Furthermore, events that can result in beat-to-beat variability of cerebral blood flow may be identified in some patients.

In the majority of patients, GM/IVH is asymptomatic and diagnosed by surveillance ultrasonography.

The parent's/caregiver's history of the patient can be entirely noncontributory; however, they might note nonspecific, subtle signs.

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Physical Examination

The physical examination is usually negative in germinal matrix/intraventricular hemorrhage (GM/IVH). Occasionally, severe GM/IVH may present with nonspecific systemic findings suggestive of cardiovascular collapse.

The presentation of GM/IVH widely varies. Most infants are asymptomatic or demonstrate subtle signs that are easily overlooked. GM/IVH is then subsequently found on surveillance sonography.

One subgroup of infants with GM/IVH presents with the following:

  • A sudden unexplained drop in hematocrit levels

  • Possible physical findings related to anemia (eg, pallor, poor perfusion) or hemorrhagic shock

Another subgroup of infants with GM/IVH presents with extreme signs, including the following:

  • A sudden and significant clinical deterioration associated with anemia, metabolic acidosis, glucose instability, respiratory acidosis, apnea, hypotonia, and stupor is present.

  • Physical findings related to these signs include poor perfusion, pallor or an ashen color, irregularities of respiratory pattern, signs of respiratory distress including retractions and tachypnea, hypotonia, and altered mental status (eg, decreased responsiveness, coma).

  • Additional neurologic signs, such as fullness of the fontanelles, seizures, and posturing, may also be observed.

  • Progression can be rapid and may result in shock and death.

  • Between the two extremes of presentation, infants may demonstrate varying degrees of neurologic and systemic signs. Those with symptoms are more likely to have a more serious grade of GM/IVH.

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