Periventricular Hemorrhage-Intraventricular Hemorrhage Follow-up

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

Further Outpatient Care

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  • Neurological follow-up
  • Developmental follow-up
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Further Inpatient Care

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  • Developmental intervention programs are indicated in individuals with periventricular hemorrhage–intraventricular hemorrhage (PVH-IVH).
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Deterrence/Prevention

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  • Antenatal steroids and the prevention of prematurity are important elements in the prevention of PVH-IVH.
  • Prevention of PVH-IVH begins with avoidance of conditions that do the following:
    • Interfere with autoregulation (eg, hypocarbia, hypercarbia, hypoxia, acidosis)
    • Overwhelm autoregulatory abilities (eg, hypertension)
    • Contribute to rapid fluctuations of cerebral blood flow (eg, ventilatory asynchrony, rapid volume expansion, noxious stimuli, frequent handling)
  • Perform correction of host factors (eg, coagulopathy, acid-base balance, hydration, hypoxia-ischemia).
  • Pharmacological prophylaxis can be accomplished through the use of indomethacin. Although the mechanism of action is currently unknown, indomethacin has been shown to reduce the incidence of PVH-IVH and, specifically, high-grade hemorrhages. [11] Follow-up of patients enrolled in a multicenter prophylaxis study conducted by Ment et al was less convincing, [10] although sex-related differences favoring treatment in male infants have been postulated. Another large multicenter trial yielded contradictory evidence. [18] With such contradictory evidence of benefit, a lack of a definitive demonstration of improvement in developmental outcomes, and a concern for complications, this therapy is not universally accepted and remains controversial.
  • In addition to effects on pulmonary development, prenatal treatment with glucocorticoids has a protective effect with regard to PVH-IVH.
  • The use of other pharmacological modalities to prevent PVH-IVH has been proposed; however, this use is not widely accepted. The other pharmacological modalities include prenatal treatment with vitamin K and phenobarbital and postnatal treatment with ethamsylate, phenobarbital, and vitamin E. Although positive reports concerning the efficacy of these agents are noted, further investigation is required to prove conclusive evidence of benefit.
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Complications

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  • Obstructive hydrocephalus
  • Nonobstructive hydrocephalus
  • Developmental impairment
  • Cerebral palsy
  • Seizures
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Prognosis

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  • Grade I and grade II hemorrhage: Neurodevelopmental prognosis is excellent (ie, perhaps slightly worse than infants of similar gestational ages without PVH-IVH).
  • Grade III hemorrhage without white matter disease: Mortality is less than 10%. Of these patients, 30-40% have subsequent cognitive or motor disorders.
  • Grade IV (severe PVH-IVH) IVH with either periventricular hemorrhagic infarction and/or periventricular leukomalacia (PVL): Mortality approaches 80%. A 90% incidence of severe neurological sequelae including cognitive and motor disturbances is noted.
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Patient Education

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  • Prenatal
    • Specific risks of gestational age
    • Sequelae
  • Postnatal
    • Provide postnatal education (if not provided previously) or reinforce prenatal education.
    • Provide results of sonography and expectations for short-term and long-term care.
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