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19/11/2011

 Intraventricular hemorrhage (IVH) is bleeding


inside or around the ventricles, the spaces in
the brain containing the cerebral spinal fluid.
 Intraventricular hemorrhage is most common
in premature babies, especially very low
birthweight babies weighing less than 1,500
grams (3 pounds, 4 ounces).

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 Causes
 It is not clear why IVH occurs.
 In a premature baby: brain are very fragile and
immature and easily rupture.
 Babies with respiratory problems such as hyaline
membrane disease, or other complications of
prematurity, are more likely to have IVH.
 The smaller and more premature the baby, the more
likely IVH will occur.
 Nearly all IVH occurs within the first three days of life.
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 The amount of bleeding varies. IVH is often described in


four grades:
 Grade 1 - bleeding occurs just in a small area of the ventricles.
 Grade 2 - bleeding also occurs inside the ventricles.
 Grade 3 - ventricles are enlarged by the blood.
 Grade 4 - bleeding into the brain tissues around the ventricles.

 Grades 1 and 2 are most common, and often there are no


further complications.
 Grades 3 and 4 are the most serious and may result in
long-term brain injury to the baby.
 Hydrocephalus (too much cerebral spinal fluid in the brain)
may develop after severe IVH.

 Symptoms
 apnea and bradycardia (stopping breathing and low heart
rate)
 pale or blue coloring (cyanosis)
 weak suck
 high-pitched cry
 seizures
 swelling or bulging of the fontanelles, the "soft spots"
between the bones of the baby's head
 anemia (low blood count)
 The symptoms of IVH may resemble other conditions
or medical problems. Always consult your baby's
physician for a diagnosis.
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 Diagnostic confirmation
 complete medical history
 physical examination
 cranial (head) ultrasound
▪ through the fontanelles, the amount of bleeding can be
graded.

 Treatment
 no specific treatment
 except to treat any other health problems that may
worsen the condition

 Giving the mother corticosteroid


medications before delivery has been shown to
lower the risk of IVH in the baby. These steroids
are often given to women between 24 and 34
weeks gestation who are at risk of early delivery.

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Location Etiology Clinically Complicati Imaging


on
Epidural accumulations Fractures of the lucid period. Herniation convex, or lens-
Hematomas of blood temporal bone shaped, and do
between the not cross suture
significant blunt
skull and the lines.
head trauma
dura

Subdural the dura and bridging veins are grow fairly slowly appear convex,
hematomas the arachnoid sheared during and the or crescent-
mater acceleration- presentation can shaped, and may
deceleration of be delayed by cross suture lines
the head days to weeks

Subarachnoid acute onset appears as blood


hemorrhage “thunderclap” in the ventricles,
headache, sulci, and cisterns
occipital or
unilateral

Cerebral appear as
(Intra- patches of bright
parenchymal) white in the
bleeds acute phase

Major Types of Neonatal Intracranial Hemorrhage and Usual Clinical Setting

Type of Hemorrhage Usual Clinical Setting

Subdural Full-term >premature; trauma


Primary subarachnoid Premature > full-term; trauma or hypoxic event(s)
Intracerebellar Premature; hypoxic event(s); trauma (?)
Periventricular-intraventricular Premature > full-term; hypoxic event(s)

From Volpe JJ. Neurology of the newborn, 3rd ed. Philadelphia: Saunders, 1995. With
permission.

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 PERDARAHAN AKIBAT DEFISIENSI VITAMIN


K (PDVK):
 Perdarahan intrakranial (63%),
 80-100% berupa perdarahan subdural dan
subaraknoid.

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