Abstract
Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.
Highlights
Germinal matrix-intraventricular hemorrhage (GM-IVH) remains a devastating neurological complication with considerable mortality [1] and neurodevelopmental disability [2]
Magnetic resonance imaging (MRI) may be performed at term corrected age for infants whose cranial ultrasound scan (CUS) reveals moderate to severe abnormalities such as grade III/IV germinal matrix (GM)-IVH, posthemorrhagic ventricular dilatation (PHVD), or grade III/IV periventricular leukomalacia (PVL), when clinical risk for white matter infarction (WMI) is increased or when parental reassurance is needed [12, 53]
A Cochrane review of three randomized controlled trials (RCTs) and a quasi-RCT found no difference between conservative management and serial tapping of cerebrospinal fluid (CSF) via lumbar puncture or ventricular tapping as regards to reduced risk of major disability, multiple disability, death, or need for permanent shunt placement [85]
Summary
Germinal matrix-intraventricular hemorrhage (GM-IVH) remains a devastating neurological complication with considerable mortality [1] and neurodevelopmental disability [2]. Hemorrhage originates in the capillary network of the subependymal germinal matrix (GM) of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle [3, 4]. Significant strides in obstetrics and neonatal medicine have led to improved survival of preterm infants with lower gestational age and birth weight [5,6,7], we seem to have reached the nib of our ability to ensure morbidity-free survival of very-low-birth-weight (VLBW) infants in advanced care settings [8, 9]. Found no significant improvement in survival without neonatal and long-term morbidity among VLBW infants between 1997 and 2002
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