Preterm hemorrhagic brain injury recent advances on evaluation and management

Abstract

GMH-IVH is a leading cause of brain injury and neurodevelopmental disability in children born preterm. cUS is the preferred modality for the diagnosis and evaluation of GMH-IVH, and an initial scan should be performed in the first days of life. Subsequent timing of cUS can be determined based on gestational age, risk factors, and the presence of previous cUS abnormalities. The management of GMH-IVH begins with preventative strategies aimed at modifiable risk factors. Once hemorrhage is detected, serial cUS is required to monitor for progression, and earlier intervention for PHVD based on ventricular measurements is recommended. PHVD interventions should begin with lumbar punctures and temporizing interventions before proceeding to VP-shunt insertion, which will be required in a subset of the affected infants. There are ongoing studies examining new therapies for PHVD including alternative neurosurgical techniques and stem cell therapy. Neurodevelopmental outcomes of GMH-IVH will vary based on grade, location, extent, the presence of PHVD, PVHI, and additional clinical risk factors.