October 2007: Grading of Intraventricular haemorrhage

[Stefan Johansson]

Leading article - October 2007
The Leading articles for October 2007 are about grading of intraventricular haemorraghes, about pros and cons of the current system for categorizing IVH into grade 1-4.

The first article are written by Alan Leviton, Karl Kuban, and Nigel Paneth, and the second article is written by Andrew Whitelaw.

The articles are published in collaboration with the journal Acta Paediatrica (http://www.blackwellpublishing.com/journal.asp?ref=0803-5253).


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Intraventricular haemorrhage grading scheme: time to abandon?
Link to the full text article (http://www.blackwell-synergy.com/doi/full/10.1111/j.1651-2227.2007.00379.x)

A different view: there is value in grading intraventricular hemorrhage
Link to the full text article (http://www.blackwell-synergy.com/doi/full/10.1111/j.1651-2227.2007.00438.x)


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You may comment the article directly below or discuss in the forum Neurology (http://www.99nicu.org/forum/forumdisplay.php?f=45).

[Marta Muresan]

Dear All

Their is another classification of intracranial haemorrhage in premature infants the paediatric section of DEGUM (Deutsche Gesellschaft für Ultraschall in der Medizin) developed a new method of classification, in 1999. This classification distinguishes more precisely between the bleeding itself and secondary changes, such as posthaemorrhagic ventricular dilation, venous parenchimal infarction:
Grade I: subependymal haemorrhage, grade II: intraventricular haemorrhages taking up < 50% of the ventricular volume, grade III: intraventricular haemorrhages of > 50% of ventricular volume. Areas of increased echo levels within the brain tissue (formerly grade IV) which are caused by haemorrhagic infarction are now taken as a separate entity. The morphological description lists the side and the location of the haemorrhagic infarction as well as its size, which is classified into 'small' (< or = 1 cm in diameter), 'medium' (1 < or = 2 cm) and large (> 2 cm). Bleeding into the basal ganglia, cerebellum and brainstem are separate entities. In post-haemorrhagic ventricular dilation the distinction is made between self-limiting transient dilation and hydrocephalus requiring treatment.
Marta Muresan,MD, pHD