Intraventricular hemorrhage and posthemorrhagic hydrocephalus in the preterm infant.

Intraventricular hemorrhage and posthemorrhagic hydrocephalus are the most important neurological complications in preterm infants during the neonatal period. The incidence of germinal matrix-intraventricular hemorrhage widely ranges from 5% to 90%, depending on the population of study. Although the incidence of intraventricular hemorrhage increases as the gestational age decreases, higher-grade hemorrhages occur more frequently in low-birth weight neonates. Infants with intraventricular hemorrhage or posthemorrhagic hydrocephalus often have poor neurodevelopmental outcomes such as seizure disorders, IQ problems, and severe motor handicaps. Several factors have been implicated in germinal matrix hemorrhage pathogenesis, including intravascular, vascular, and extravascular factors. Any situation leading to an alteration in the cerebral blood flow and/or central nervous system blood pressure may develop into a germinal matrix and intraventricular hemorrhage in the preterm infant. Diagnosis is often difficult to determine based on clinical criteria alone, but availability and information of cranial ultrasound studies are key to definite diagnosis. Modalities of treatment include drugs that decrease cerebrospinal fluid (CSF) production and surgical interventions to transiently or permanently shunt CSF fluid. Permanent CSF shunts are nowadays the only proven treatment in cases of progressive posthemorrhagic hydrocephalus, although they are subjected to frequent complications. Prevention of prematurity itself is the key to decrease the number of shunt-dependent patients.