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Book

Periventricular and Intraventricular Hemorrhage

Ryan Starr  1 , Orlando De Jesus  2 , Sanket D. Shah  3 , Judith Borger  4
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
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Book

Periventricular and Intraventricular Hemorrhage

Ryan Starr et al.
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Excerpt

Periventricular-intraventricular hemorrhage (PIVH) is a disease process that affects the premature newborn infant. Hemorrhage occurs when vessels of the germinal matrix in the periventricular area rupture, which can then extend into the ventricles as intraventricular hemorrhage (IVH). In severe cases, bleeding will occupy a significant portion of the ventricle and extend into the intraparenchymal area. Infants most at risk are those born before 33 weeks of gestational age, as after this time, the germinal matrix involutes.

The second most frequent cause of death in preterm infants is PIVH and is one of the leading causes of cerebral damage in low birth-weight preterm newborns. Hyaline membrane disease is the most frequent cause of death in preterm infants.

Intraventricular hemorrhage (IVH) was first discovered by Abraham Towbin in 1968. In 1978 Papile et al. developed a classification for PIVH based on the head computed tomographic scan. This classification was later adapted in 1984 for ultrasound as the equipment is portable and can be frequently repeated.

The degree of hemorrhage is graded I through IV:

  1. Grade I – hemorrhage limited to Germinal matrix

  2. Grade II – IVH without ventricular dilatation

  3. Grade III - IVH with ventricular dilatation occupying > 50% of the ventricle

  4. Grade IV – IVH with intraparenchymal hemorrhage

Grade III and IV are termed as “severe IVH”.

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Conflict of interest statement

Disclosure: Ryan Starr declares no relevant financial relationships with ineligible companies.

Disclosure: Orlando De Jesus declares no relevant financial relationships with ineligible companies.

Disclosure: Sanket Shah declares no relevant financial relationships with ineligible companies.

Disclosure: Judith Borger declares no relevant financial relationships with ineligible companies.

References

    1. Novak CM, Ozen M, Burd I. Perinatal Brain Injury: Mechanisms, Prevention, and Outcomes. Clin Perinatol. 2018 Jun;45(2):357-375. - PubMed
    1. Marba ST, Caldas JP, Vinagre LE, Pessoto MA. Incidence of periventricular/intraventricular hemorrhage in very low birth weight infants: a 15-year cohort study. J Pediatr (Rio J) 2011 Nov-Dec;87(6):505-11. - PubMed
    1. Towbin A. Cerebral intraventricular hemorrhage and subependymal matrix infarction in the fetus and premature newborn. Am J Pathol. 1968 Jan;52(1):121-40. - PMC - PubMed
    1. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978 Apr;92(4):529-34. - PubMed
    1. Bowerman RA, Donn SM, Silver TM, Jaffe MH. Natural history of neonatal periventricular/intraventricular hemorrhage and its complications: sonographic observations. AJR Am J Roentgenol. 1984 Nov;143(5):1041-52. - PubMed

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