Ventricular Hemorrhage
Neurological Disorders in Newborns, NOVA Publications , ss.139-150, 2025
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2025
- Yayınevi: NOVA Publications
- Sayfa Sayıları: ss.139-150
- Anahtar Kelimeler: Cranial ultrasound, Germinal matrix-intraventricular hemorrhage, Observation, Prematurity, Risk factors, Treatment
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Germinal matrix-intraventricular hemorrhage (GMH-IVH) is the most frequently seen type of neonatal intracranial hemorrhage. It is one of the most significant problems in premature infants. Despite a significant amount of information about the etiology and treatment strategies to reduce the incidence of GMH-IVH in this patient population, it continues to be a great problem. As a major complication of prematurity, GMH-IVH is seen in inverse proportion to gestational age and birthweight. Although the pathophysiology is well known, as prematurity cannot be prevented, it remains a current problem in infants born before 32 weeks. In 50% of premature infants, hemorrhage occurs in the first 24 hours postnatally, and germinal matrix hemorrhage is seen at the rate of 25% on the second day, 15% on the third day, and 10% after the third day. Significant risk factors for GMH-IVH are low birthweight, early neonatal sepsis, hypotension, hypoxemia, hypercapnia, and respiratory distress syndrome requiring intervention, positive pressure during the birth, long-term mechanical ventilation, pneumothorax, low APGAR score, seizure, patent ductus arteriosus, frequency of endotracheal respiration, the use of surfactant because of respiratory distress syndrome, female gender, chorioamnionitis, painful stimuli, hypothermia, and thrombocytopenia. Cranial ultrasound (US) is recommended once a week in Grade I-II hemorrhages, and twice a week for Grade III and parenchymal hemorrhages. When performing cranial US, evaluations should be made in respect of diagnoses such as choroid plexus papilloma, Galen vein aneurysm, cystic lesions, masses, ventriculomegaly, and hydrocephaly. In the follow-up of ventricle dimensions, ventricular index, anterior horn width, and thalamo- occipital distance measurements are evaluated according to the postmenstrual weeks. The decision on the timing of interventions is made jointly by brain and neurosurgery specialists based on serial cranial US follow-ups performed by radiologists and/or qualified neonatologists, along with advanced tests (brain MRI, brain tomography). In cases requiring treatment, treatment options can be selected according to the patient's status. These options include serial lumbar punction, transarachnoid punction (TAP), external ventricular drainage (EVD), ventriculo-peritoneal shunt (VP shunt), intraventricular reservoir (subgaleal shunt), and endoscopic third ventriculostomy. Close follow-up by pediatric neurologists and developmental pediatricians in respect of neurodevelopment is recommended for these patients.