Intraventricular Hemorrhage and Post-Hemorrhagic Ventricular Dilatation

Germinal-intraventricular hemorrhage is still a common complication in infants who are born prematurely. The onset of the hemorrhage is in the germinal matrix, a brain structure that contains a dense network of immature vessels. The immature vessels are susceptible to fluctuations in blood flow, which can occur in preterm infants due to the lack of cerebral autoregulation. A distinction is made between low-grade hemorrhage and severe hemorrhage. Severe hemorrhages are more likely to have a complicated course, including post-hemorrhagic ventricular dilatation and risk for severe long-term developmental deficits. The risk of unilateral spastic cerebral palsy is especially high when a hemorrhage goes along with a parenchymal hemorrhagic infarction. However, the occurrence and severity of cerebral palsy depend on the location and extent of the parenchymal hemorrhagic infarction. Both ultrasound and MRI can detect germinal-intraventricular hemorrhage, although MRI is better at detecting small hemorrhages in the temporal and occipital germinal matrix and associated (subtle) white matter injury. Timely detection of germinal-intraventricular hemorrhage and particularly possible complications allows for timely intervention, important for the prevention of (severe) long-term disabilities.