====== Periventricular-intraventricular hemorrhage clinical features ======

===== Asymptomatic PIVH =====

Most PIVHs will be clinically unsuspected, usually with smaller hemorrhages. Retrospectively, these
PIVHs may have been suggested by a fall in [[hematocrit]] or delays in neurologic development. These have a 78% 6-month survival, vs. 20%for PIVH showing signs.

===== Subacute presentation =====

Usually smaller or more slowly developing hemorrhages. Clinically may present as irritability, reduced motor activity, or abnormal eye movements.

===== Acute presentation =====

1. changes in muscle tone or activity: usually decerebrate or decorticate posturing, sometimes flac-
cid paralysis

2. seizures: often subclinical

3. tense fontanelle

4. hypotension

5. respiratory and cardiac irregularities: [[apnea]] & [[bradycardia]] (“A’s and B’s”)

6. unreactive pupils and/or loss of extraocular muscle movements

7. Hematocrit drop > 10%
----
Awareness of [[risk factor]]s for the development of [[hydrocephalus]] in newborn infants with [[germinal matrix hemorrhage]] should be emphasized in order to enable an early [[diagnosis]] of [[ventriculomegaly]] and symptomatic hydrocephalus and thus make a correct therapeutic decision
((Romero L, Ros B, Arráez M, Ríus F, González L, Martín A, Carrasco A, Segura M.
Analysis of risk factors for hydrocephalus development in newborn infants with
germinal matrix hemorrhage. Minerva Pediatr. 2015 Oct;67(5):401-6. PubMed PMID:
26377778.
)).

[[Seizure]]s: often subclinical.
There is high riskwhen the seizure is the clonic type. When the seizure is subtle type the risk is low to this etiology
((de Holanda MR, de Melo AN. [Prediction of etiology based on the clinical type of convulsion in the neonatal period]. Acta Cir Bras. 2005;20 Suppl 1:227-31. Portuguese. PubMed PMID: 17768811.)).

Hypoxic-ischemic encephalopathy is the most common cause of neonatal seizures. Multiple etiologies often co-exist in neonates and hence it is essential to rule out conditions such as hypoglycemia, [[hypocalcemia]], and meningitis before initiating specific therapy
((Sankar MJ, Agarwal R, Aggarwal R, Deorari AK, Paul VK. Seizures in the
newborn. Indian J Pediatr. 2008 Feb;75(2):149-55. PubMed PMID: 18334796.
)).

Tense [[fontanelle]]

[[Hypotension]]

[[As and Bs]]