Intraventricular Hemorrhage in Premature Infants: A Review of Risk Factors, Pathology, Treatment, and Prognosis

Abstract

Abstract Intraventricular hemorrhage (IVH) in newborns is defined as bleeding within the ventricles, surrounded by the brain. This condition is most commonly observed in premature newborns and is directly proportional to gestational age; the smaller the gestational age, the higher the risk of IVH. It typically occurs in the subependymal germinal matrix, a highly vascularized area undergoing significant development in newborns and regression in full-term infants. The etiology is multifactorial and primarily attributed to the intrinsic fragility of the vascularization of the germinal matrix. Risk factors for IVH in premature infants include the immaturity of the cerebral vascular system, fluctuations in blood pressure, hypoxia, and oxidative stress. Furthermore, clinical factors such as respiratory distress syndrome, mechanical ventilation, and coagulation disorders contribute to the vulnerability of preterm infants to this complication. Regarding treatment, interventions can range from careful monitoring and medical support to surgical procedures such as cerebrospinal fluid drainage or ventriculoperitoneal shunting in severe cases. Pharmacological therapy, including the use of anti-inflammatory drugs, may be implemented to minimize brain injuries. Complications of IVH include obstructive hydrocephalus, non-obstructive hydrocephalus, post-hemorrhagic hydrocephalus, developmental disorders, cerebral palsy, and seizures. In conclusion, IVH in premature infants remains a complex and delicate issue in neonatology. An integrated approach covering both prevention and treatment is essential to minimize the negative impact of this complication on the neurological development of premature infants. Continuous research is necessary to develop innovative and effective strategies for managing this critical problem in neonatal medicine. Transfontanelar ultrasound remains the election method for diagnosis. Mild and moderate forms have shown favorable progression, while severe IVH has led to the development of post-hemorrhagic obstructive hydrocephalus.