Ultrasonic evaluation of neonatal subependymal-intraventricular hemorrhage and its complications

This study demonstrates the value of neurosonography in the evaluation of subependymal-intraventricular hemorrhage (SEH-IVH) and its major complications in the premature infant. Real time sector scans were performed on 150 premature neonates within first 24 hours of life (mean, 10 hrs), and then at 48, 72, and 96 hours and thereafter at weekly intervals. The incidence of SEH-IVH was 22% (n = 33). Twenty seven of the 33 infants had small hemorrhages (Grade I & II), 4 infants sustained Grade III hemorrhage and 2 infants had Grade IV hemorrhage. All hemorrhages occurred in the first 96 hours of life; 50% being diagnosed with the first scan. Larger grades of hemorrhages were generally symptomatic while majority of patients with small hemorrhages had no associated symptoms. The infants especially at risk were those less than 32 weeks' gestation (odds ratio, 29 fold) and/or birth-weight < 1200 gms (odds ratio, 6 fold). Three infants developed post hemorrhagic ventriculomegaly which subsided spontaneously in two of them by the age of 4 weeks. One infant progressed to post hemorrhagic hydrocephalus. The mortality in the study group was 11.3% (n = 17) and correlated to the severity of hemorrhage (39% vs 3.4%; hemorrhagic vs non hemorrhagic group, p < 0.001). At least one screening sonogram is essential within first 4 days of life to diagnose SEH-IVH, which may be otherwise clinically silent. Once the hemorrhage is diagnosed, followup evaluations may be done at weekly intervals to detect post-hemorrhagic ventriculomegaly.