Özek Eren, Kersin Sinem Gülcan
Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, Pendik Training and Research Hospital, İstanbul, Turkey.
Turk Pediatri Ars. 2020 Sep 23;55(3):215-221. doi: 10.14744/TurkPediatriArs.2020.66742. eCollection 2020.
Germinal matrix-intraventricular hemorrhage (GM-IVH) is a major complication of prematurity and inversely associated with gestational age and birth weight. The hemorrhage originates from the germinal matrix with an immature capillary bed where vascularization is intense and active cell proliferation is high. It occurs in around 20% of very low-birth-weight preterm neonates. Germinal matrix-intraventricular hemorrhage is less common in females, the black race, and with antenatal steroid use, but is more common in the presence of mechanical ventilation, respiratory distress, pulmonary bleeding, pneumothorax, chorioamnionitis, asphyxia, and sepsis. Ultrasonography is the diagnostic tool of choice for intraventricular hemorrhage and its complications. Approximately 25-50% of the germinal matrix-intraventricular hemorrhage cases are asymptomatic and diagnosed during routine screening. These cases are usually patients with low-grade hemorrhage. Neurologic findings are prominent in severe intraventricular hemorrhage cases. The major complications of the germinal matrix-intraventricular hemorrhage in preterm babies are periventricular hemorrhagic infarction, posthemorrhagic ventricular dilatation, periventricular leukomalacia, and cerebellar hemorrhage. It is an important cause of mortality and morbidity. The management of hemodynamics and ventilation of patients, appropriate follow-up, and early diagnosis and treatment can minimize morbidity. Prognosis in intraventricular hemorrhage is related to the severity of bleeding, parenchymal damage, and the presence of seizures and shunt surgery. The main determinant of prognosis is periventricular hemorrhagic infarction and its severity. Moderate-severe intraventricular hemorrhage can cause posthemorrhagic hydrocephalus, cerebral palsy, and mental retardation. Even mild germinal matrix-intraventricular hemorrhage can result in developmental disorders. Long-term problems such as neurodevelopmental disorders and cerebral palsy are as important as short-term problems. Improving the quality of life of these babies should be aimed through appropriate treatment and follow-up. In this review, intraventricular hemorrhage and complications are discussed.
脑室周围-脑室内出血（GM-IVH）是早产的主要并发症，与胎龄和出生体重呈负相关。出血起源于生发基质，此处毛细血管床不成熟，血管化强烈且细胞增殖活跃。约20%的极低出生体重早产儿会发生这种出血。脑室周围-脑室内出血在女性、黑人种族以及使用产前类固醇的情况下较少见，但在机械通气、呼吸窘迫、肺出血、气胸、绒毛膜羊膜炎、窒息和败血症的情况下更常见。超声检查是诊断脑室内出血及其并发症的首选工具。约25%-50%的脑室周围-脑室内出血病例无症状，在常规筛查时被诊断出来。这些病例通常是轻度出血的患者。严重脑室内出血病例中神经系统表现突出。早产婴儿脑室周围-脑室内出血的主要并发症是脑室周围出血性梗死、出血后脑室扩张、脑室周围白质软化和小脑出血。它是死亡和发病的重要原因。对患者进行血流动力学和通气管理、适当的随访以及早期诊断和治疗可将发病率降至最低。脑室内出血的预后与出血严重程度、实质损伤、癫痫发作和分流手术的存在有关。预后的主要决定因素是脑室周围出血性梗死及其严重程度。中重度脑室内出血可导致出血后脑积水、脑瘫和智力障碍。即使是轻度的脑室周围-脑室内出血也可能导致发育障碍。神经发育障碍和脑瘫等长期问题与短期问题同样重要。应通过适当的治疗和随访来提高这些婴儿的生活质量。在本综述中，将讨论脑室内出血及其并发症。
