Periventricular Hemorrhage-Intraventricular Hemorrhage Treatment & Management

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

Medical Care

Supportive care includes the correction of underlying medical disturbances that might be related to the development of periventricular hemorrhage–intraventricular hemorrhage (PVH-IVH) as well as cardiovascular, respiratory, and neurological support.

  • Correction of anemia, acidosis, and hypotension, as well as ventilatory support, might be required in those neonates who present with acute deterioration.
  • Serial lumbar puncture, although once used to prevent progressive hydrocephalus, is not indicated.
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Surgical Care

Surgical support for PVH-IVH is limited to intervention for posthemorrhagic hydrocephalus. Because most patients with hydrocephalus following PVH-IVH demonstrate spontaneous resolution within weeks of onset, surgical intervention is usually unnecessary.

  • Serial lumbar punctures have been used to manage early hydrocephalus. However, because spontaneous resolution of hydrocephalus is usually observed, the use of this intervention has been questioned. A multicenter evaluation of serial lumbar punctures demonstrated no benefit when the individual with PVH-IVH is aged 30 months. The role of serial lumbar punctures in the management of late or rapidly progressive hydrocephalus remains controversial.
  • Acetazolamide may be used to diminish CSF production and limit late or rapidly progressive hydrocephalus. Its use in the treatment of early ventricular dilatation is probably limited.
  • Ventriculostomy placement may be required for the management of significant hydrocephalus while awaiting definitive surgical drainage.
  • Ventriculoperitoneal and ventriculosubgaleal shunting remain the definitive treatments for posthemorrhagic hydrocephalus requiring surgical intervention.
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Consultations

See the list below:

  • Consult neurosurgery in the event of rapidly progressive ventricular enlargement or prolonged (>4 wk) slowly progressive ventricular enlargement.
  • Neurology consultation might be of value in the event of intractable seizures in an individual with PVH-IVH.
  • A developmental interventionist might be of help with a patient with high-grade hemorrhages.
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