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Germinal matrix-intraventricular hemorrhage in the premature newborn: management and outcome
1Division of Neurology, University of British Columbia, British Columbia's Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada.
Insights
Germinal matrix-intraventricular hemorrhage (GMH-IVH) in premature newborns stems from fragile capillary rupture. Prevention strategies exist, but outcomes depend on hemorrhage severity and complications, with long-term academic and behavioral issues common in very low birth weight infants.
Area of Science:
- Neonatal neurology
- Pediatric critical care
Background:
- Germinal matrix-intraventricular hemorrhage (GMH-IVH) is a significant concern in premature infants.
- It arises from the rupture of fragile germinal matrix capillaries.
Purpose of the Study:
- To review the pathogenesis, prevention, and outcomes of GMH-IVH in premature newborns.
- To highlight the long-term neurodevelopmental consequences.
Main Methods:
- Literature review on GMH-IVH pathogenesis.
- Analysis of factors influencing GMH-IVH severity and outcomes.
- Examination of long-term academic and behavioral sequelae.
Main Results:
- GMH-IVH pathogenesis involves pressure-passive cerebral circulation, blood flow fluctuations, coagulation issues, and microvascular fragility.
- Interventions can prevent GMH-IVH.
- Hemorrhage severity, parenchymal involvement, and complications like hydrocephalus dictate outcomes.
- Very low birth weight (VLBW) infants face persistent academic and behavioral problems, even without initial neuroimaging abnormalities.
Conclusions:
- GMH-IVH is a complex condition with multifactorial causes in premature infants.
- Effective prevention strategies are available.
- Long-term neurodevelopmental deficits, including academic and behavioral issues, are prevalent in VLBW survivors and require ongoing management.
Abstract:
Germinal matrix-intraventricular hemorrhage (GMH-IVH) in the premature newborn results from rupture of fragile capillaries in the germinal matrix. Its pathogenesis is multifactorial and relates principally to a pressure-passive cerebral circulation, fluctuations in cerebral blood flow, and derangements of coagulation and fragility of the germinal matrix microvasculature. Several interventions have beneficial effects for prevention of GMH-IVH. Outcome after GMH-IVH relates largely to the severity of hemorrhage, the extent of hemorrhagic and ischemic parenchymal involvement, and complications (e.g., posthemorrhagic hydrocephalus). Even in the absence of neuroimaging abnormalities, VLBW infants have a high incidence of academic and behavioral problems which persist into adolescence and early adulthood.
