Beyond the bleed: Navigating fetal intraventricular hemorrhage.

Area of Science:

• Neonatal Neurology
• Fetal Medicine
• Genetics

Background:

• Antenatal intraventricular hemorrhage (IVH), occurring in utero, has a 1-5 per 10,000 incidence.
• Fetal intracranial hemorrhages carry a poor prognosis, with up to 40% mortality and less than 50% of survivors experiencing normal neurodevelopmental outcomes.
• Limited data exists on the neurodevelopmental prognosis of antenatally diagnosed intracranial hemorrhages.

Purpose of the Study:

• To present a case of a healthy term infant with a prenatally diagnosed grade IV fetal IVH.
• To highlight the neurodevelopmental outcome in a case of severe antenatal IVH associated with a genetic syndrome.
• To contribute to the understanding of outcomes for fetal intracranial hemorrhage.

Main Methods:

• Case report of a term infant diagnosed with unilateral grade IV IVH and bilateral cerebral ventriculomegaly prenatally.
• Post-natal evaluation including MRI, infectious, and hematologic assessments.
• Genetic testing revealing a 15q11.2 deletion syndrome.

Main Results:

• The infant was discharged home on day 18, tolerating feeds and gaining weight appropriately.
• Serial neuroimaging showed no progression of the hemorrhage.
• At 6 months of age, the infant was meeting all developmental milestones.

Conclusions:

• Despite the generally poor prognosis associated with fetal intracranial hemorrhage (ICH), especially grade III or IV, favorable outcomes are possible.
• Genetic factors may play a role in the presentation and outcome of antenatal IVH.
• This case underscores the importance of comprehensive evaluation and individualized counseling for parents regarding fetal ICH.