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Conquer NEET PG 2022:Intraventricular Hemorrhage | Pediatric | Let's Crack NEET PG | Dr.Anand Bhatia

Let's Crack NEET PG・2 minutes read

Intraventricular hemorrhage in Pediatrics was discussed by Dr. Anand, highlighting key exam topics as part of the "Conquer NEET PG" initiative, emphasizing causes, presentations, and management strategies for timely diagnosis. Ultrasound Cranium is the preferred imaging for IVH screening, focusing on grades, symptoms, and consequences in newborns to ensure effective management and care.

Insights

  • Intraventricular hemorrhage is more common in preterm infants due to fragile brain vessels in the germinal matrix, while term babies are less affected due to improved vascular integrity after 34 weeks.
  • Understanding the various grades and presentations of intraventricular hemorrhage, along with the importance of timely diagnosis through ultrasound imaging and recognizing clinical signs like hematocrit changes, is crucial for effective management in newborns.

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Recent questions

  • What is intraventricular hemorrhage?

    Bleeding in the brain's ventricles, common in preterm infants.

  • How is intraventricular hemorrhage diagnosed?

    Ultrasound Cranium is the preferred imaging method.

  • What are the consequences of intraventricular hemorrhage?

    Damage to germinal matrix, hemorrhagic infarction, and hydrocephalus.

  • Who is at high risk for intraventricular hemorrhage?

    Babies under 32 weeks or less than 1.5 kg.

  • How is hypoglycemia treated in newborns?

    10% dextrose is administered based on severity.

Related videos

Summary

00:00

"Pediatrics: Intraventricular Hemorrhage Exam Essentials"

  • The topic discussed is intraventricular hemorrhage in Pediatrics by Dr. Anand, focusing on essential exam topics.
  • The discussion is part of the "Conquer NEET PG" initiative, covering 60 crucial topics for exam success.
  • The Plus subscription on the Unacademy app offers access to live and recorded lectures by various educators worldwide.
  • The iconic subscription includes prep ladder access, clinical notes, question banks, and rapid revision tools.
  • Special classes on the Unacademy app and YouTube cover Pediatrics topics, with interactive features like polls and doubt clarification.
  • The most common cause of non-communicating hydrocephalus is aqueductal stenosis, affecting CSF flow between ventricles.
  • Intraventricular hemorrhage is common in preterm infants due to fragile and thin brain vessels.
  • The germinal matrix is the primary site of intraventricular hemorrhage in preterm infants.
  • In term babies, intraventricular hemorrhage is less common as the germinal matrix involutes and vascular integrity improves after 34 weeks.
  • A question from Ames 2019 highlighted intracranial bleeding in premature infants, emphasizing the importance of understanding the germinal matrix's role in hemorrhage.

15:30

"IVH in Newborns: Diagnosis and Management"

  • CSF is formed by the choroid plexus in the brain, flowing through the lateral ventricle, third ventricle, and fourth ventricle.
  • Intra ventricular Hemorrhage (IVH) has four grades: Grade 1 is confined to the germinal matrix, Grade 2 involves 10-50% of the lateral ventricle without enlargement, Grade 3 involves more than 50% of the lateral ventricle with ventricular enlargement, and Grade 4 is peri ventricular hemorrhagic infarction.
  • Ultrasound Cranium is the imaging of choice for screening and diagnosing IVH due to the ideal window provided by the anterior fontanella, ease of use, quick acquisition, and lack of radiation hazard.
  • The anterior fontanella closes by 8-18 months, offering a window for ultrasound imaging.
  • IVH babies can present as clinically silent, saltatory, or catastrophic, with clinically silent being the most common and catastrophic being the least common presentation.
  • The only clinical sign of IVH may be an unexplained fall in hematocrit due to hemoglobin breakdown.
  • Clinically silent presentation is characterized by a sudden and unexplained pallor in the baby's condition.
  • A sudden and rapid deterioration in the baby's condition within a day may indicate IVH, as seen in a case study of a preterm baby.
  • Polycythemia can lead to increased hematocrit levels, while low hemoglobin levels can cause a decrease in hematocrit levels.
  • Understanding the different presentations and signs of IVH is crucial for timely diagnosis and management in newborns.

31:29

Neonatal IVH: Symptoms, Screening, and Consequences

  • PCV, or packed cell volume, is also known as hematocrit.
  • Symptoms of IVH can be silent or catastrophic, with lethargy, apnea, and tone abnormalities.
  • Silent IVH can progress over days to weeks, while catastrophic IVH evolves rapidly within hours.
  • The Ballard score assesses neuromuscular and physical maturity, with a maximum score of 5 for skin and popliteal angle.
  • Decorticate and decerebrate postures are seen in abnormal flexion and extension, respectively.
  • High-risk babies, under 32 weeks or less than 1.5 kg, should be screened for IVH.
  • Babies between 32 to 34 weeks with a bad neonatal course should also be screened for IVH.
  • Consequences of IVH include damage to the germinal matrix, periventricular hemorrhagic infarction, and post-hemorrhagic hydrocephalus.
  • Periventricular hemorrhagic infarction results from IVH affecting the germinal matrix.
  • Post-hemorrhagic hydrocephalus occurs due to blockage in the aqueduct of Sylvius, leading to CSF accumulation and hydrocephalus.

49:20

Neonatal Mortality Rates and Hypoglycemia Treatment

  • The latest under five mortality rate is 39, with infant mortality rate at 34, neonatal mortality rate at 24, early neonatal mortality rate at 18, and late neonatal mortality rate at 6.
  • The cutoff for hypoglycemia in newborns is less than 45 mg/dL for neonatal hypoglycemia and less than 54 mg/dL for hypoglycemia in severe acute malnutrition.
  • The fluid of choice for hypoglycemia is 10% dextrose, with 2 ml per kg for neonatal hypoglycemia and 5 ml per kg for severe hypoglycemia.
  • The 10 steps of warm chain for preventing hypothermia in a child include warming the delivery room, immediate drying, skin-to-skin contact, breastfeeding, postponed bathing, appropriate clothing, keeping mother and baby together, professional alertness, and warm transportation.
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