Management consists primarily of supportive care; i.e. anticonvulsant therapy for
seizures, blood pressure support, transfusion if indicated, etc.
Grade I: Serial HUS to rule out extension of IVH, if no extension, follow clinically
Grade II: Serial HUS
If ventricular size is unchanged, follow clinically as with Grade I If ventricle
enlarges, treat as with Grade III
Grades III & IV: Serial HUS to track size of ventricle
If ventricles continue to enlarge, serial lumbar punctures (LP) may be required. The
frequency of LP is dictated by clinical status and response to LP. An intraventricular
reservoir to tap CSF may be necessary.
Because of the increased incidence of IVH in the NICU population, as well as the
increased incidence of periventricular leukomalacia (PVL) in the same subset, at-risk
infants (<1500gm or depressed infants) in the NICU are screened at 1 week, 1 month
and/or 36weeks CGA, unless clinical status necessitates earlier evaluation.
VI. PERIVENTRICULAR LEUKOMALACIA (PVL)
The most common form of brain injury in preterm infants is diffuse PVL. It is also the
most common cause of neurologic deficit and cerebral palsy in at risk infants. PVL
refers to focal necrosis and gliosis of white matter dorsal and lateral to the exterior