1. IVH in Preterm Infants Sue Ann Smith

2. Preterm Neonates - IVH Gestation usually less than 32 weeks, but may occur in more mature preterm infants May rarely occur in the term neonate The primary site of hemorrhage is the germinal matrix. A secondary site is the choroid plexus - especially in the more mature infant

3. IVH timing Set up for IVH usually present at birth Bleeding usually not present before 24 hours, 75% of all IVH seen by 72 hours, and > 95% by 1 week of age. Risk of new IVH after 1 weeks is very low. Still need to follow for PVL, which is not usually detectable for 4-6 weeks by US.

4. Grading IVH by Ultrasound Grade I - Germinal matrix hemorrhage (GMH) without extension into the ventricle Grade II - GMH with extension of blood into ventricle, but without distension of ventricle. Grade III - GMH with distension of ventricle.

5. Intraparenchymal hemorrhage Intraparenchymal ischemia/hemorrhage in periventricular area (sometimes called Grade IV IVH) Periventricular ischemia –may lead to hemorrhagic infarct –or to non-hemorrhagic infarct Areas of infarct become necrotic and are “cleaned up” to become holes –periventricular leukomalacia (PVL) –porencephalic cyst(s)

6. Normal Cranial Ultrasound

7. Abnormal Cranial Ultrasounds

8. Cranial Ultrasound with Parenchymal Hemorrhage Coronal and sagittal views of intraparenchymal hemorrhage

9. PVL