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Neuropathologic findings in short-term survivors of intraventricular hemorrhage
Insights
Intraventricular hemorrhage (IVH) in preterm infants is rarely isolated. Most infants with IVH also have other serious brain abnormalities, impacting prevention and treatment strategies.
Area of Science:
- Neonatal Neurology
- Pediatric Pathology
Background:
- Intraventricular hemorrhage (IVH) affects 31-43% of low birth weight infants (<1500g).
- IVH is often associated with other cerebral pathologies, rarely occurring as an isolated finding.
Purpose of the Study:
- To investigate the frequency and types of associated cerebral abnormalities in infants diagnosed with IVH.
- To determine if IVH is an isolated lesion or part of a broader spectrum of brain injury in preterm neonates.
Main Methods:
- Autopsy examination of 24 brains from infants diagnosed with IVH who survived at least one week.
- Verification of IVH diagnosis and documentation of co-existing cerebral lesions.
Main Results:
- IVH diagnosis was confirmed in 20 infants; 2 had misdiagnosed choroid plexus hemorrhage, and 2 had no evident IVH.
- Eleven infants (46%) had associated choroid plexus hemorrhage.
- Twenty-two infants (92%) exhibited additional cerebral abnormalities, including periventricular leukomalacia, brainstem necrosis, hydrocephalus, and cerebellar necrosis.
Conclusions:
- Intraventricular hemorrhage is seldom an isolated finding in preterm infants.
- Associated brain lesions are common and must be considered in the clinical management and treatment of IVH survivors.
Abstract:
Intraventricular hemorrhage (IVH) occurs in 31% to 43% of infants weighing less than 1500 g. Intraventricular hemorrhage is rarely an isolated lesion at autopsy. To document associated cerebral abnormality, 24 brains of infants with a diagnosis of IVH and who survived for at least one week were examined. The diagnosis was verified in 20 infants. Choroid plexus hemorrhage and brain calcification had been misdiagnosed as IVH in two infants and in two other infants, IVH was not evident at autopsy. Eleven infants (46%) had choroid plexus hemorrhage. Twenty-two infants (92%) had additional cerebral abnormalities: periventricular leukomalacia, brainstem necrosis, hydrocephalus, or cerebellar necrosis. This study demonstrates that IVH is rarely an isolated abnormality in the preterm infant brain. The associated brain lesions should be considered in attempts to prevent or treat IVH and their presence should be suspected during clinical assessment of survivors.