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Intraventricular Hemorrhage in the Newborn

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Pediatric Neurosurgery for Clinicians

Abstract

Intraventricular hemorrhage (IVH) remains an unresolved and serious complication in the management of prematurity, despite significant advances in neonatal intensive care management. Subsequent progressive ventricular enlargement results in post-hemorrhagic hydrocephalus (PHH), which is an important challenge in neurosurgical treatment. The pathogenesis of IVH mainly derives from the fragile microvasculature in the germinal matrix (GM) and unstable cerebral blood flow associated with this area. PHH causes periventricular white matter injury, resulting in significant permanent neurodevelopmental deficits. Although several therapeutic interventions have been implemented, the majority of premature infants eventually require permanent ventriculo-peritoneal (VP) shunt placement.

The prevalence of IVH in preterm infants has significantly decreased over the last few decades, but increased survival of extremely low birth weight (ELBW) infants suggests that severe IVH with subsequent PHH remains a serious unsolved problem.

This chapter summarizes current concepts of the pathophysiology, diagnosis, and management of PHH, its underlying clinical challenges, and ongoing research.

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Abbreviations

AHW:

Anterior horn width

CP:

Cerebral palsy

CSF:

Cerebrospinal fluid

DRIFT:

DRainage, Irrigation, and Fibrinolytic Therapy

ELBW:

Extremely low birth weight

ETV:

Endoscopic third ventriculostomy

EVD:

External ventricular drainage

EVL:

Endoscopic ventricular lavage

GM:

Germinal matrix

IVH:

Intraventricular hemorrhage

PHH:

Post-hemorrhagic hydrocephalus

TOD:

Thalamo-occipital dimension

TROPHY:

Treatment of post-hemorrhagic hydrocephalus registry study

TVW:

Third ventricular width

VAD:

Ventricular access device

VLBW:

Very low birth weight

VP:

Ventriculo-peritoneal

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Authors and Affiliations

  1. Department of Neurosurgery, Nara Medical University, Nara, Japan

    Young-Soo Park

  2. Division of Neurosurgery, Children’s Medical Center, Nara Medical University Hospital, Nara, Japan

    Young-Soo Park

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Correspondence to Young-Soo Park .

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Editors and Affiliations

  1. Neurosurgery, University of Ioannina, Ioannina, Greece

    Georgios Alexiou

  2. Neurosurgery, “Mitera’’ Children’s Hospital, Marousi, Greece

    Neofytos Prodromou

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Park, YS. (2022). Intraventricular Hemorrhage in the Newborn. In: Alexiou, G., Prodromou, N. (eds) Pediatric Neurosurgery for Clinicians. Springer, Cham. https://doi.org/10.1007/978-3-030-80522-7_4

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  • DOI: https://doi.org/10.1007/978-3-030-80522-7_4

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