Germinal matrix hemorrhage: can be detected effectively

Abstract

The germinal matrix hemorrhage corresponds to a cerebrovascular event originated in its blood vessels, it is prevalent in premature babies and is the first cause of infant mortality in Ecuador; Its inadequate diagnosis has an important impact on the neurodevelopment of premature infants and can generate serious sequelae that may be greater depending on the degree of prematurity, especially in premature infants weighing 500 to 750 g at birth. One of the main tools to diagnose womb bleeding is transfontanelar ultrasound, which is fundamental in the detection and early management of the situation. It should be considered that it requires an experienced radiologist to identify and interpret the findings. Some associated risk factors are: gestational age, low birth weight, low Apgar score, acidosis, and neonatal asphyxia. The factors that are involved in bleeding can be: intravascular, vascular and extravascular. The degrees can range from Grade I (hyperechogenic mass due to the presence of clots, the choroid plexus looks thickened in the trigone region), Grade II (in which the hemorrhage extends to the cisterna magna, which increases the risk of hydrocephalus) , Grade III in which the clot will become more anechoic over time, the presence of blood in the CSF can cause chemical ventriculitis) and Grade IV (with paraventricular hypercogenecity with involvement of the frontal and parietal lobes). Transfontanelar ultrasound can detect various brain lesions in the premature newborn, including bleeding from the germ matrix and periventricular leukomalacia. The main cause of leukomalacia is hypoxic-ischemic events, so that the lesions predominate in the periventricular white matter. The use of this technique is recommended for the timely diagnosis of bleeding in newborns with risk factors.