What is Cranial Ultrasound Evaluation of Intraventricular Hemorrhage in Preterm Neonates?
Cranial ultrasound evaluation is a crucial part of preterm neonatal care in general, and unstable and high-risk premature infants, in particular. Cranial ultrasound evaluation utilizes sound waves to produce images of the brain and cerebrospinal fluid to detect common congenital and acquired brain abnormalities, such as intraventricular hemorrhage (IVH).
Intraventricular hemorrhage in preterm neonates is a medical condition defined by the presence of bleeding around or inside the ventricles of the brain. The ventricles are the spaces in the brain that consists of cerebral spinal fluid. Bleeding within the brain can put immense pressure on the nerve cells leading to severe damage of the cells resulting in brain injury. IVH is the most common type of neonatal intracranial hemorrhage and occurs primarily in preterm infants ≤32 weeks of gestation.
Depending on the amount of bleeding occurring within the brain of preterm neonates, IVH can be graded into 4 types, including:
- Grade 1, where bleeding occurs in a small area of the ventricles.
- Grade 2, where bleeding also occurs inside the ventricles.
- Grade 3, where bleeding causes ventricles to be enlarged.
- Grade 4, where bleeding occurs in the brain tissues around the ventricles.
Grades 1 and 2 are the most common with babies having no other complications, whereas grades 3 and 4 are the most serious resulting in long-term brain injury to the baby.
Risk Factors of Intraventricular Hemorrhage in Preterm Neonates
Certain babies are more prone to intraventricular hemorrhage, including:
- Babies weighing less than 3.5 pounds
- Premature babies
- Babies with breathing issues
- Labour and delivery issues
- Genetic elements
- Head injury
- Shaken baby
- High blood pressure in the mother
- Infection in the mother
- Blood clotting problems
Causes of Intraventricular Hemorrhage in Preterm Neonates
The causes of IVH is unknown. Bleeding may occur because of fragile blood vessels in a premature baby’s brain that can easily rupture. Most cases of IVH occurs within the first few days of life.
Symptoms of Intraventricular Hemorrhage in Preterm Neonates
Some of the common symptoms of IVH include the following:
- Apnoea (pauses in breathing)
- Cyanosis (pale or blue coloring)
- Bradycardia (slow heart rate)
- Seizures
- High-pitched cry
- Weak sucking reflex
- Reduced reflexes
- Reduced muscle tone
- Abnormal eye movement
- Lethargy, stupor, or coma
Diagnosis of Intraventricular Hemorrhage in Preterm Neonates
Your baby’s doctor will first review the baby’s health history and conduct a thorough physical exam. Cranial ultrasound evaluation is required for confirmation of the diagnosis. The cranial ultrasound evaluation utilizes sound waves to produce images of the internal structures of the brain. Your doctor can view the inside of the baby’s brain through the fontanelles and grade the amount of bleeding accordingly.
Procedure for Cranial Ultrasound Evaluation
A cranial ultrasound is a safe and painless test that usually takes about 15 to 30 minutes and is performed by a sonographer (a technician trained in ultrasound imaging) either in a hospital or outpatient setting.
The common steps involved include the following:
- The baby will be lying down on a bed or examination table either on their stomach or back position. The baby can also be held in the parent’s lap.
- The room is usually dark so the images can be seen clearly on the computer screen.
- The sonographer will apply a clear, warm gel on the baby’s scalp. The gel assists with the transmission of the sound waves.
- A small handheld device called a transducer is moved over the gel on the baby’s scalp back and forth gently.
- The transducer emits high-frequency sound waves and a computer measures how the sound waves bounce back from the head.
- The computer converts those sound waves into images to be analyzed.
Treatment of Intraventricular Hemorrhage in Preterm Neonates
There is no specific treatment for IVH, except to treat any other health problems that may make the condition worse. Sometimes surgery may be required to stabilize your baby’s condition.
Although care of sick and preterm neonates has advanced considerably, it is not possible to avert IVH from occurring. But if you are at risk of early delivery, your doctor may provide you with corticosteroid medicines. This has been reported to reduce the risk of IVH in the baby. These steroids are mostly prescribed to women between 24 to 34 weeks of pregnancy if they are at risk of early delivery.
