Abstract
Germinal matrix-intraventricular hemorrhage (GMH-IVH) is a serious problem in the small preterm infants. The hemorrhage originates from the germinal matrix with an immature capillary bed. The etiology of IVH is complex and multifactorial and is primarily based on the intrinsic fragility of the germinal matrix vessels and the disturbance in the cerebral blood flow.
Premature infants with severe IVH are at high risk of posthemorrhagic hydrocephalus, cerebral palsy, and mental retardation. Even infants with mild IVH are at risk of developmental disabilities.
Approximately 30–50% of infants, who had severe IVH, develop posthemorrhagic ventricular dilatation, and 20–40% of these cases require permanent ventriculoperitoneal shunt.
The main aims of the intervention carried out in posthemorrhagic ventricular dilatation (PHVD) are to minimize the need for the VP shunt and to prevent the secondary damage to the brain caused by the pressure, inflammation, and free radicals. The optimal clinical management of PHVD still remains unclear. A most common approach today is the temporary treatment of hydrocephalus with ventricular access device, ventriculosubgaleal shunt, and less frequently external ventricular drains (EVD). Ventriculoperitoneal shunt is still the main surgical procedure.
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Ahn SY, Chang YS, Park WS (2014) Mesenchymal stem cells transplantation for neuroprotection in preterm infants with severe intraventricular hemorrhage. Korean J Pediatr 57(6):251–256
Al-Abdi SY, Al-Aamri MA (2014) Systematic review and meta-analysis of the timing of early ıntraventricular hemorrhage in preterm neonates: clinical and research implications. J Clin Neonatol 3(2):76–88
Al-Wassia H, Shah PS (2015) Efficacy and safety of umbilical cord milking at birth: a systematic review and meta-analysis. JAMA Pediatr 169(1):18–25
Armstrong DL, Sauls CD, Goddard Finegold J (1987) Neuropathologic findings in short term survivors of intraventricular hemorrhage. Am J Dis Child 141:617–621
Babnik J, Stucin-Gantar I, Kornhauser L, Sinkovec J, Wraber B, Derganc M (2006) Intrauterine inflammation and the onset of peri-intraventricular hemorrhage in premature infants. Biol Neonate 90:113–121
Backes CH, Rivera BK, Haque U, Bridge JA, Smith CV, Hutchon DJ, Mercer JS (2014) Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis. Obstet Gynecol 124(1):47–56
Badhiwala JH, Hong CJ, Nassiri F, Hong BY, Riva-Cambrin J, Kulkarni AV (2015) Treatment of posthemorrhagic ventricular dilation in preterm infants: a systematic review and meta-analysis of outcomes and complications. J Neurosurg Pediatr 28:1–11
Bassan H (2009) Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol 36(4):737–762
Bassan H, Limperopoulos C, Visconti K, Mayer DL, Feldman HA, Avery L, Benson CB, Stewart J, Ringer SA, Soul JS (2007) Neurodevelopmental outcome in survivors of periventricular hemorrhagic infarction. Pediatrics 120(4):785–792
Beaino G, Koshnood B, Kaminski M, Marret S, Pierrat V, Vieux R, Thirez G, Matis J, Picaud JC, Roze JC, Alberge C, Larroque B, Breart G, Ancel PY (2011) Epipage study group: predictors of the risk of cognitive deficiency in very preterm infants: the epipage prospective cohort. Acta Paediatr 100:370–378
Berger A (2000) Long term experience with subcutaneously tunneled external ventricular drainage in preterm. Childs Nerv Sys 16:103–106
Bhandari V, Bizarro MJ, Shetty A, Zhong X, Page GP, Zhang H, Ment LR, Gruen JR (2006) Familial and genetic susceptibility to major neonatal morbidities in preterm twins. Pediatrics 117(6):1901–1906
Bilguvar K, Di Luna M, Bizarro M, Bayri Y, Schneider KC, Lifton RP, Gunel M, Ment LR (2009) Col4A1 mutation in preterm intraventricular hemorrhage. J Pediatr 155(5):743–745
Brouwer AJ, Groenendaal F, Benders MJNL, de Vries LS (2014) Early and late complications of germinal matrix-intraventricular hemorrhage in the preterm infant: what is new? Neonatology 106:296–303
Brouwer AJ, Groenendaal F, Han KS, de Vries LS (2015) Treatment of neonatal progressive ventricular dilatation: a single center experience. J Mater Fetal Neonatal Med 28(S1):2273–2279
Brouwer MJ, de Vries LS, Kersbergen KJ, van der Aa NE, Brouwer AJ, Viergever MA, Isgum I, Han KS, Groenendaal F, Benders MJ (2016) Effects of posthemorrhagic ventricular dilatation in the preterm infant on brain volumes and white matter diffusion variables at term equivalent age. J Pediatr 168:41–49
Buxton N, Macarthur D, Malluci C (1998) Neuroendoscopic third ventriculostomy in patients less than 1 year old. Pediatr Neurosurg 29:73–76
Chapman IA, Hansen NI, Stoll BJ, Higgins R (2008) Neurodevelopmental outcome of extremely low birthweight infants with posthemorrhagic hydrocephalus requiring shunt insertion. Pediatrics 121(5):1167–1177
Dalton J, Dechert RE, Sarkar S (2015) Assessment of association between rapid fluctuations in serum sodium and intraventricular hemorrhage in hypernatremic preterm infants. Am J Perinatol 32(8):795–802
Dani C, Poggi C, Bertini G, Pratesi S, Di Tommaso M, Scarcelli G, Rubaltelli FF (2010) Method of delivery and intraventricular hemorrhage in extremely preterm infants. J Matern Fetal Neonatal Med 23(12):1419–1423
Davies MW, SwaminathanM CSL, Betheras FR (2000) Reference ranges for the linear dimensions of the intracranial ventricles in preterm neonates. Arch Dis Child Fetal Neonatal Ed 82:F218–F223
Fenton TR (2003) A new growth chart for preterm babies: Babson and Benda’s chart updated with recent data and updated format. BMC Pediatr 3:13–21
Harding DR, Sukbhir D, Whitelaw A, Humphries SE, Marlow N, Montgomery E (2004) Does IL6 genotype influence cerebral injury or developmental progress after birth. Pediatrics 114(4):941–947
Hartel C, König I, Köster S, Kuhls E, Küster H, Möller J, Müller D, Kribs A, Segerer H, Wieg C, Herting E, Göpel W (2006) Genetic polymorphisms of hemostasis genes and primary outcome of very low birthweight infants. Pediatrics 118(2):683–689
Ingram MCE, Huguenard AL, Brandon AM, Chern JJ (2014) Poor correlation between head circumference and cranial ultrasound findings in premature infants with intraventricular hemorrhage. J Neurosurg Pediatrics 14:184–189
International PHVD Drug Trial group (1998) International randomised controlled trial of acetazolamide and furosemide in posthemorrhagic ventricular dilatation in infancy. Lancet 352(9126):433–440
Klebermass Schrehof K, Czaba C, Olischar M, Fuiko R, Waldhoer T, Rona Z, Pollak A, Weninger M (2012) Impact of low grade intraventricular hemorrhage on long term neurodevelopmental outcome in preterm infants. Childs Nerv Sys 28:2085–2092
Klebermass-Schrehof K, Rona Z, Waldhor T, Czaba C, Beke A, Weninger M, Olischar M (2012) Can neurophysiological assessment improve timing of intervention in posthemorrhagic ventricular dilatation? Arch Dis Child Fetal Neonatal Ed 98:F291–F297
Köksal V, Öktem S (2010) Ventriculosubgaleal shunt procedure and its long-term outcomes in premature infants with posthemorrhagic hydrocephalus. Child Nerv Syst 26(11):1505–1515
Kuperman AA, Brenner B, Kenet G (2015) Intraventricular hemorrhage in preterm infants-can we improve outcome by addressing coagulation? J Matern Fetal Neonatal Med 28(Suppl 1):2265–2267
Lam HP, Heilman CB (2009) Ventricular access device versus ventriculosubgaleal shunt in posthemorrhagic hydrocephalus associated with prematurity. J Matern Fetal Neonatal Med 22(11):1097–1101
Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, Verter J, Temprosa M, Wright LL, Ehrenkranz RA, Fanaroff AA, Stark A, Carlo W, Tyson JE, Donovan EF, Shankaran S, Stevenson DK (2001) Very low birthweight outcomes of NICHD neonatal research network. Pediatrics 107(1):E1
Levene M (1981) Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound. Arch Dis Child 56:900–904
Limbrick DD, Mathur A, Johnston JM, Munro S, Sagar J, Inder T, Park TS, Leonard JR, Smyth MD (2010) Neurosurgical treatment of progressive posthemorrhagic ventricular dilation in preterm infants: a 10 year single institution study. J Neurosurg Pediatr 6(3):224–230
Lou HC, Lassen NA, Friis –HB (1979) Impaired autoregulation of cerebral blood flow in the distressed newborn infant. J Pediatr 94:118–121
Lu H, Wang Q, Lu J, Zhang Q, Kumar P (2016) Risk factors for intraventricular hemorrhage in preterm infants born at 35 weeks or less following preterm rupture of membranes. J Stroke Cerebrovasc Dis 25(4):807–812 https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.12.011, pii: S1052-3057(15)00678-3
Massimi L, Di Rocco C (2013) Surgical treatment of posthemorrhagic infantile hydrocephalus. Minerva Pediatr 65(4):417–425
Mazzola CA, Choudhri AF, Auguste KI, Limbrick DD, Rogido M, Mitchell L, Flannery AM (2014) Pediatric hydrocephalus systematic review and evidence-based guidelines task force. Part 2: management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr 14(Suppl 1):8–23
Ment LR, Aden U, Lin A, Kwon SH, Choi M, Hallman M, Lifton RP, Zhang H, Bauer CR, Gene targets for IVH Study Group (2014) Gene-environment interactions in severe intraventricular hemorrhage of preterm neonates. Pediatr Res 75(1–2):241–250
Mirza H, Laptook AR, Oh W, Vohr BR, Stoll BJ, Kandefer S, Stonestreet BS, Generic Database Subcommittee of the NICHD Research Network (2016) Effects of indomethacin prophylaxis timing on intraventricular hemorrhage and patent ductus arteriosus in extremely low birthweight infants. Arch Dis Child Fetal Neonatal Ed 101(5):F418–F422. https://doi.org/10.1136/archdischild-2015-309112
Morita T, Morimoto M, Yamada K, Hasegawa T, Morioka S, Kidowaki S, Moroto M, Yamashita S, Maeda H, Chiyonobu T, Tokuda S, Hosoi H (2015) Low grade intraventricular hemorrhage disrupts cerebellar white matter in preterm infants. Evidence from diffusion tensor imaging. Neuroradiology 57(5):507–514
Papile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weight less than 1500 gm. J Pediatr 92:529–534
Parodi A, Morana G, Severino MS, malova M, Natalizia AR, sannia A, Rossi A, Ramenghi LA (2015) Low grade intraventricular hemorrhage: is ultrasound good enough? J Matern Fetal Neonatal Med 28(S1):2261–2264
Pediatric Society of Canada (2001) Routine screening cranial ultrasound examinations for the prediction of long term neurodevelopmental outcomes in preterm infants. Paediatr Child Health 6(1):39–43
Peng W, Zhu H, Shi H, Liu E (2014) Volume targeted ventilation is more suitable than pressure –limited ventilation for preterm infants: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 99(2):F158–F165
Plaisier A, Raets MMA, Goossen GME, Govaert P, Roon MF, Reiss IKM, Smit LS, Lequin MH, Dudink J (2015) Serial ultrasonography or early MRI for detecting preterm brain injury. Arch Dis Child Fetal Neonatal Ed 100:F293–F300
Radic JA, Vincer M, McNeely PD (2015) Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population – based cohort of very preterm infants born to residents of Nova Scotia from 1993-2010. J Neurosurg Pediatr 15(6):580–588
Rüegger CM, Hagmann CF, Bührer C, Held L, Bucher HU, Wellmann S, EpoRepair Investigators (2015) Erythropoietin for the repair of cerebral injury in very preterm infants (EpoRepair). Neonatology 108(3):198–204
Schreiner C, Suter S, Watzka M, Hertfelder HJ, Schreiner F, Oldenburg J, Bartmann P, Heep A (2014) Genetic variants of the vitamin K dependent coagulation system and intraventricular hemorrhage in preterm infants. BMC Pediatr 14(1):219
Skinner JR, Milligan DWA, Hunter S, Hey EN (1992) Central venous pressure in the ventilated neonate. Arch Dis Child 67:374–377
Takenouchi T, Perlman JM (2012) Intraventricular hemorrhage and white matter injury in the preterm infant. In: Perlman JM, Polin RA (eds) Neurology, neonatology questions and controversies, 1st edn. Elsevier Saunders, Philedelphia, pp 27–45
Taylor GA, Madsen JR (1996) Neonatal hydrocephalus: hemodynamic response to Fontanelle compression – correlation with intracranial pressure and need for shunt placement. Radiology 201:685–689
Taylor AG, Peter JC (2001) Advantages of delayed VP shunting in posthemorrhagic hydrocephalus seen in low birthweight infants. Childs Nerv Syst 17:328–333
Tioseco JA, Aly H, Essers J, Patel K, El- Mohandes AA (2006) Male sex and intraventricular hemorrhage. Pediatr Crit Care Med 7(1):40–44
Van Bel F, Van de Bor M, Stijnen T, Baan J, Ruys JH (1987) Aetiological role of cerebral blood flow alterations in development and extension of peri-intraventricular hemorrhage. Dev Med Child Neurol 29:601–614
Volpe JJ (2008) Intracranial hemorrhage: germinal matrix – intraventricular hemorrhage of the premature infant. In: Volpe JJ (ed) Neurology of the newborn, 5th edn. Elsevier, Philadelphia, pp 517–588
De Vries LS, Brouwer AJ, Groenendaal F (2013) Posthaemorrhagic ventricular dilatation: when should we intervene? Arch Dis Child Fetal Neonatal Ed 98:F284–F285
Wang JY, Amin AG, Jallo GI, Ahn ES (2014) Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate. J Neurosurg Pediatr 14(5):447–454
Wang JY, Jackson EM, Jallo GI, Ahn ES (2015) Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency. CNS 31(11):2123–2130
Werner EF, Savitz DA, Janevic TM, Ehsanipoor RM, Thung SF, Funai EF, Lipkind HS (2012) Mode of delivery and neonatal outcomes in preterm, small for gestational age newborns. Obstet Gynecol 120(3):560–564
Werner EF, Han CS, Savitz DA, Goldhore M, Lipkind HS (2013) Health outcomes for vaginal compared with cesarean delivery of appropriately grown preterm neonates. Obstet Gynecol 121(6):1195–1200
Whitelaw A (2001a) Repeated lumbar or ventricular punctures in newborns with IVH Cochrane Database Syst Rev 1:CD000216
Whitelaw A (2001b) Diuretic therapy in PHVD, Cochrane Database Syst Rev 2:CD002270
Whitelaw A (2012) Posthemorrhagic hydrocephalus management strategies. In: Perlman JM, Polin RA (eds) Neurology, neonatology questions and controversies, 1st edn. Elsevier Saunders, Philadelphia, pp 47–62
Whitelaw A, Aquilina K (2012) Management of posthemorrhagic ventricular dilatation. Arch Dis Child Fetal Neonatal Ed 97(3):F 229–F 303
Whitelaw A, Odd DE (2007) Intraventricular streptokinase after intraventricular hemorrhage in newborn infants. Cochrane Database Sys Rev (4):CD000498
Whitelaw A, Mowinkel MC, Abildgaard U (1995) Low levels of plasminogen in cerebrospinal fluid after intraventricular hemorrhage. Acta Pediatr 84:933–936
Whitelaw A, Christie S, Pople I (1999) Transforming growth factor β1: a possible signal molecule for posthemorrhagic hydrocephalus ? Pediatr Res 46:576–580
Whitelaw A, Pople I, Cherian S (2003) Phase 1 trial of prevention of hydrocephalus after intraventricular hemorrhage in newborn infants by drainage, irrigation, and fibrinolytic therapy. Pediatrics 111:759–765
Whitelaw A, Jary S, Kamita G (2010) Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years. Pediatrics 125:e852–e858
Zaben M, Finnigan A, Bhatti MI, Leach P (2015) The initial neurosurgical interventions for the treatment of posthemorrhagic hydrocephalus in preterm infants: a focused review. Br J Neurosurg 15:1–4
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Özek, E., Özek, M.M. (2019). Germinal Matrix-Intraventricular Hemorrhage and Posthemorrhagic Ventricular Dilatation in the Preterm Infant. In: Cinalli, G., Özek, M., Sainte-Rose, C. (eds) Pediatric Hydrocephalus. Springer, Cham. https://doi.org/10.1007/978-3-319-27250-4_49
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DOI: https://doi.org/10.1007/978-3-319-27250-4_49
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