Paeds Vivas · fetal-neonatal-and-perinatal
Intraventricular haemorrhage and periventricular leukomalacia — branching viva
Branching viva from the recognition of IVH and PVL through the Papile grading, the prevention bundle, and the DRIFT-versus-shunt decision with family-centred counselling.
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RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the neonatal registrar on the NICU. The consultant asks you to talk through four preterm infants: one who suddenly deteriorated after a pneumothorax, one whose routine day-7 scan showed a grade III bleed with ventricular dilation, one with cystic periventricular leukomalacia, and one whose parents are asking what could have prevented the bleed and what the future holds.
Station opening
Examiner: "Define intraventricular haemorrhage and periventricular leukomalacia, and explain why they are grouped together as the injuries of the preterm brain." [1] [5]
Strong candidate (must-hit)
- Defines IVH as bleeding from the fragile germinal matrix that enters the ventricular system, and PVL as injury to the periventricular white matter from ischaemia and inflammation of premyelinating oligodendrocytes; explains they are grouped because they share the periventricular anatomy, the same risk profile of prematurity and haemodynamic instability, and because a severe IVH often coexists with or directly causes white-matter injury. [1] [5]
Weak candidate
- "IVH is a brain bleed in premature babies, and PVL is damage to the brain substance." [1]
References7ShowHide
- [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.PMID 305471
- [2]Ment LR; Oh W; Ehrenkranz RA; et al Low-dose indomethacin and prevention of intraventricular hemorrhage: a multicenter randomized trial. Pediatrics, 1994.PMID 8134206
- [3]Schmidt B; Roberts RS; Davis P; et al Caffeine therapy for apnea of prematurity. N Engl J Med, 2006.PMID 16707748
- [4]Rabe H; Gyte GM; Díaz-Rossello JL; Duley L Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev, 2019.PMID 31529790
- [5]Volpe JJ Dysmaturation of Premature Brain: Importance, Cellular Mechanisms, and Potential Interventions. Pediatr Neurol, 2019.PMID 30975474
- [6]Whitelaw A; Evans D; Carter M; et al Randomized clinical trial of prevention of hydrocephalus after intraventricular hemorrhage in preterm infants: brain-washing versus tapping fluid. Pediatrics, 2007.PMID 17403819
- [9]O'Shea TM; Kuban KC; Allred EN; et al Neonatal cranial ultrasound lesions and developmental delays at 2 years of age among extremely low gestational age children. Pediatrics, 2008.PMID 18762501