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The incidence, timing, and predisposing factors of germinal matrix and intraventricular hemorrhage (GMH/IVH) in preterm neonates

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Abstract

Background

Germinal matrix and intraventricular hemorrhage (GMH/IVH) is a known complication occurring in the first week of life in preterm neonates. However, the precise time of its occurrence and the ideal time to perform diagnostic imaging studies remain controversial. The purpose of this paper is to address these two issues in our patient population to allocate our resources to those at highest risk.

Materials and methods

This study included 282 premature newborns (under 37 weeks of gestation) that were admitted to our neonate ICU in a year’s time and screened for GMH/IVH. They were grouped in four categories according to their weight at birth, and according to their gestational age. All patients had a daily cranial ultrasound during the first week. It was then repeated once in the second week and once in the third.

Results

We found that the incidence of GMH/IVH among preterm neonates was 44.68%. It was inversely related to the weight and the age of the newborn. The onset of bleeding coordinated with the occurrence of hypoxia and respiratory distress requiring mechanical ventilation. The majorities occurred in the first 7 days of life; they were mostly grade I and II according to the Papule classification and silent for the most part. Complications were present in 41% of the survivors.

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References

  1. Alvarez MD, Villamil M, Reyes G (1994) Predictive factors in the genesis of intraventricular hemorrhage in premature infants. P R Health Sci J 13(4):251–254

    PubMed  CAS  Google Scholar 

  2. Batton DG, DeWitte DB, Boal DK, Nardis EE, Maisels MJ (1986)Incidence and severity of intraventricular hemorrhage: 1981–1984. Am J Perinatol 3(4):353–356

    PubMed  CAS  Google Scholar 

  3. Burguet A, Monnet E, Roth P, Hirn F, Vouaillat C, Lecourt-Ducret M, Fromentin C, Dornier L, Helias J, Choulot MJ, Allemand H, Maillet R, Menget A (2000) Neurodevelopmental outcome of premature infants born at less than 33 weeks of gestational age and not cerebral palsy at the age of 5 years. Arch Pediatr 7(4):357–368

    Article  PubMed  CAS  Google Scholar 

  4. Chen CH, Wang TM, Wu KH, Chi CS (1993) Intraventricular hemorrhage in preterm neonates—a two-year experience. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 34(5):343–348

    PubMed  CAS  Google Scholar 

  5. Cherian S, Whitelaw A, Thoresen M, Love S (2004) The pathogenesis of neonatal post-hemorrhagic hydrocephalus. Brain Pathol 14(3):305–311

    Article  PubMed  CAS  Google Scholar 

  6. De Vries LS, Rademaker KJ, Groenendaal F, Eken P, van Haastert IC, Vandertop WP, Gooskens R, Meiners LC (1998) Correlation between neonatal cranial ultrasound, MRI in infancy and neurodevelopmental outcome in infants with a large intraventricular haemorrhage with or without unilateral parenchymal involvement. Neuropediatrics 29(4):180–188

    Article  PubMed  Google Scholar 

  7. Enzmann D, Murphy-Irwin K, Stevenson D, Ariagno R, Barton J, Sunshine P(1985) The natural history of subependymal germinal matrix hemorrhage. Am J Perinatol 2(2):123–133

    PubMed  CAS  Google Scholar 

  8. Ferrari B, Tonni G, Luzietti R, Ciarlini G, Vadora E, Merialdi A(1992) Neonatal complications and risk of intraventricular–periventricular hemorrhage. Clin Exp Obstet Gynecol 19(4):253–258

    PubMed  CAS  Google Scholar 

  9. Goldsmith, Karotkin (1996) Assisted ventilation of the neonate. Saunders, Philadelphia, PA, pp 397–408

    Google Scholar 

  10. Hamrick SE, Miller SP, Leonard C, Glidden DV, Goldstein R, Ramaswamy V, Piecuch R, Ferriero DM (2004) Trends in severe brain injury and neurodevelopmental outcome in premature newborn infants: the role of cystic periventricular leukomalacia. J Pediatr 145(5):593–599

    Article  PubMed  Google Scholar 

  11. Harke HT, Haeye RI, Storch A et al (1972)Perinatal Cerebral hemorrhage. J Pediatr 37:80

    Google Scholar 

  12. Hayden CK Jr, Shattuck KE, Richardson CJ, Ahrendt DK, House R, Swischuk LE (1985) Subependymal germinal matrix hemorrhage in full-term neonates. Pediatrics 75 (4):714–718

    PubMed  Google Scholar 

  13. Jaeger M, Grussner SE, Omwandho CO, Klein K, Tinneberg HR, Klingmuller V (2004) Cranial sonography for newborn screening: a 10-year retrospective study in 11,887 newborns. Rofo 176(6):852–858

    PubMed  CAS  Google Scholar 

  14. Pomerance JJ, Richardson J (1993) Neonatology for the clinician, 1st edn. Applenton & Lange, Norwalk, Connecticut, pp 425–435

    Google Scholar 

  15. Leech RW, Kohnen P (1974) Subependymal and intraventricular hemorrhages in the newborn. Am J Pathol 77(3):465–475

    PubMed  CAS  Google Scholar 

  16. Linder N, Haskin O, Levit O, Klinger G, Prince T, Naor N, Turner P, Karmazyn B, Sirota L (2003) Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study. Pediatrics 111(5 Pt 1):e590–e595

    Article  PubMed  Google Scholar 

  17. McMenamin JB, Shackelford GD, Volpe JJ (1984) Outcome of neonatal intraventricular hemorrhage with periventricular echodense lesions. Ann Neurol 15(3):285–290

    Article  PubMed  CAS  Google Scholar 

  18. Ment LR, Duncan CC, Ehrenkranz RA, Lange RC, Taylor KJ, Kleinman CS, Scott DT, Sivo J, Gettner P (1984) Intraventricular hemorrhage in the preterm neonate: timing and cerebral blood flow changes. J Pediatr 104(3):419–425

    Article  PubMed  CAS  Google Scholar 

  19. Ment LR, Duncan CC, Scott DT, Ehrenkranz RA (1984) Post hemorrhagic hydrocephalus. Low incidence in very low birth weight neonates with intraventricular hemorrhage. J Neurosurg 60(2):343–347

    Article  PubMed  CAS  Google Scholar 

  20. Paneth N, Pinto-Martin J, Gardiner J, Wallenstein S, Katsikiotis V, Hegyi T, Hiatt IM, Susser M (1993) Incidence and timing of germinal matrix/intraventricular hemorrhage in low birth weight infants. Am J Epidemiol 137(11):1167–1176

    PubMed  CAS  Google Scholar 

  21. Papile LA, Burstein J, Burstein R, Koffler H ( 1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 92(4):529–534

    Article  PubMed  CAS  Google Scholar 

  22. Partridge JC, Babcock DS, Steichen JJ, Han BK (1983) Optimal timing for diagnostic cranial ultrasound in low-birth-weight infants: detection of intracranial hemorrhage and ventricular dilation. J Pediatr 102(2):281–287

    Article  PubMed  CAS  Google Scholar 

  23. Perlman JM, Volpe JJ (1986) Intraventricular hemorrhage in extremely small premature infants. Am J Dis Child 140(11):1122–1124

    PubMed  CAS  Google Scholar 

  24. Philip AG, Allan WC, Tito AM, Wheeler LR (1989) Intraventricular hemorrhage in preterm infants: declining incidence in the 1980’s. Pediatrics 84(5):797–801

    PubMed  CAS  Google Scholar 

  25. Roland EH, Hill A (2003) Germinal matrix-intraventricular hemorrhage in the premature newborn: management and outcome. Neurol Clin 21(4):833–851 (vi–vii)

    Article  PubMed  Google Scholar 

  26. Sann L, Bourgeois J, Stephant A, Putet G (2001) Outcome of 249 premature infants, less than 29 weeks gestational age. Arch Pediatr 8(3):250–258

    Article  PubMed  CAS  Google Scholar 

  27. Schellinger D, Grant EG, Manz HJ, Patronas NJ (1988) Intraparenchymal hemorrhage in preterm neonates: a broadening spectrum. Am J Roentgenol 150(5):1109–1115

    PubMed  CAS  Google Scholar 

  28. Staneva KN, Hartmann S, Uhlemann M, Dietze H, Reschke E, Koepcke E, Sadenwasser W, Kulz T (2002) Neonatal ultrasonographic cerebral findings: association with risk factor for cerebral palsy. Z Geburtshilfe Neonatol 206(4):142–150

    Article  PubMed  CAS  Google Scholar 

  29. Szymonowicz W, Yu VY (1986) Periventricular haemorrhage and leukomalacia in extremely low birthweight infants. Aust Paediatr J 22(3):207–210

    PubMed  CAS  Google Scholar 

  30. Takashima S, Becker LE (1983) Intraventricular and subependymal haemorrhage in infants dying within 10 hours of birth. Brain Dev 5(1):9–13

    PubMed  CAS  Google Scholar 

  31. Trounce JQ, Rutter N, Levene MI (1986) Periventricular leucomalacia and intraventricular haemorrhage in the preterm neonate. Arch Dis Child 61(12):1196–1202

    Article  PubMed  CAS  Google Scholar 

  32. Tsiantos A, Victorin L, Relier JP, Dyer N, Sundell H, Brill AB, Stahlman M. (1974) Intracranial hemorrhage in the prematurely born infant: timing of clots and evaluation of clinical signs and symptoms. J Pediatr 85(6):854–859

    Article  PubMed  CAS  Google Scholar 

  33. Urlesberger B, Muller W ( 2004) Prognosis of preterm infants with a birth weight <1,501 g. Gynakol Geburtshilfliche Rundsch 44(1):19–24

    Article  PubMed  CAS  Google Scholar 

  34. Valleur D, Magny JF, Rigourd V, Kieffer F (2004) Mid and long-term neurological prognosis of preterm infants less than 28 weeks gestational age. J Gynecol Obstet Biol Reprod 33(1 Suppl):S72–S78 (Feb)

    CAS  Google Scholar 

  35. Vohr B, Ment LR (1996) Intraventricular hemorrhage in the preterm infant. Early Hum Dev 44(1):1–16

    Article  PubMed  CAS  Google Scholar 

  36. Vollmer B, Roth S, Baudin J, Stewart AL, Neville BG, Wyatt JS (2003) Predictors of long-term outcome in very preterm infants: gestational age versus neonatal cranial ultrasound. Pediatrics 112(5):1108–1114

    Article  PubMed  Google Scholar 

  37. Volpe JJ (1989) Intraventricular hemorrhage and brain injury in the premature infant. Diagnosis, prognosis, and prevention. Clin Perinatol 16(2):387–411

    PubMed  CAS  Google Scholar 

  38. Volpe JJ (1989) Intraventricular hemorrhage in the premature infant—current concepts. Part I. Ann Neurol 25(1):3–11

    Article  PubMed  CAS  Google Scholar 

  39. Volpe JJ (1989) Intraventricular hemorrhage in the premature infant—current concepts. Part II. Ann Neurol 25(2):109–116

    Article  PubMed  CAS  Google Scholar 

  40. Whitelaw A, Cherian S, Thoresen M, Pople I (2004) Posthaemorrhagic ventricular dilatation: new mechanisms and new treatment. Acta Paediatr Suppl 93(444):11–14

    PubMed  CAS  Google Scholar 

  41. Wildrick D (1997) Intraventricular hemorrhage and long-term outcome in the premature infant. J Neurosci Nurs 29(5):281–289

    PubMed  CAS  Google Scholar 

  42. Zaramella P, Lago P, Freato F, Battajon N, Saia OS, Chiandetti L (2004) Retrospective analysis of post-hemorrhagic ventricular dilatation in very low birth weight infants, short and long-term outcome. Minerva Pediatric 56(5):527–536

    CAS  Google Scholar 

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Correspondence to Hassan Kadri.

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Kadri, H., Mawla, A.A. & Kazah, J. The incidence, timing, and predisposing factors of germinal matrix and intraventricular hemorrhage (GMH/IVH) in preterm neonates. Childs Nerv Syst 22, 1086–1090 (2006). https://doi.org/10.1007/s00381-006-0050-6

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  • DOI: https://doi.org/10.1007/s00381-006-0050-6

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