Intraventricular Hemorrhage in Term Neonates: Sources, Severity and Outcome

Objective
Intraventricular hemorrhage (IVH) occurs in preterm infants; however, the
occurrence of this event is less frequent in term neonates. The present study
evaluated clinical characteristics, pathophysiological features, and early
outcome of term neonates with IVH in a referral neonatal center in Iran.

Materials & Methods
This study was performed on 30 full-term neonates admitted to the Neonatal
Intensive Care Unit (NICU) of Ali-Asghar Hospital, Tehran, Iran between
March 2005 and April 2011. IVH was diagnosed using cranial ultrasonography,
or brain magnetic resonance imaging (MRI).

Results
The mean age at onset of symptoms was 3.9 days. Seizure was the commonest
clinical symptoms followed by poor feeding and fever. The sources of
bleeding in the brain were choroid plexus (60%), germinal matrix (20%) and
parenchyma (6.7%). Severity of bleeding included 33.3% grade I, 30.0% grade
II, 36.7% grade III to IV. Fifteen (50%) cases had coagulopathy. Twenty-five
(83.3%) cases were discharged with a good condition, three (10%) cases were
referred to surgical ward and two cases (6.7%) died in NICU.

Conclusion
The main source of IVH in term neonates is choroid plexus; the most common
clinical symptoms include seizure and poor feeding, and one-third of IVH
events are graded as III to IV. Most affected neonates are discharged from
NICU without CNS complication, about 10% need to refer to surgical
interventions, and death was occurred in a few of neonates.