alte, sids, and diseases of prematurity
DESCRIPTION
ALTE, SIDS, and Diseases of Prematurity. Chris McCrossin, PGY 3 Thanks to: Kelly Millar, Bella Sztukowski, Ian Wishart, and Jay Green. objectives. Understand the underlying etiologies for ALTE’s, what to look for on history and physical exam - PowerPoint PPT PresentationTRANSCRIPT
ALTE, SIDS, and Diseases ALTE, SIDS, and Diseases of Prematurityof Prematurity
ALTE, SIDS, and Diseases ALTE, SIDS, and Diseases of Prematurityof Prematurity
Chris McCrossin, PGY 3
Thanks to: Kelly Millar, Bella Sztukowski, Ian Wishart, and Jay Green
Chris McCrossin, PGY 3
Thanks to: Kelly Millar, Bella Sztukowski, Ian Wishart, and Jay Green
objectivesobjectives
Understand the underlying etiologies for ALTE’s, what to look for on history and physical exam
Gain an appreciation for what we understand as the natural history and future risk to those presenting with ALTE’s and how it compares and contrasts to SIDS
Know what constitutes an appropriate ED evaluation, work-up, and disposition of ALTE cases
SIDS (definitions, addressing parental questions, appropriate recommendations, identify risk in future siblings)
Diagnoses associated with prematurity:
Bronchopulmonary dysplasia
SAH
NEC
Understand the underlying etiologies for ALTE’s, what to look for on history and physical exam
Gain an appreciation for what we understand as the natural history and future risk to those presenting with ALTE’s and how it compares and contrasts to SIDS
Know what constitutes an appropriate ED evaluation, work-up, and disposition of ALTE cases
SIDS (definitions, addressing parental questions, appropriate recommendations, identify risk in future siblings)
Diagnoses associated with prematurity:
Bronchopulmonary dysplasia
SAH
NEC
CasesCases
1. 3 week old infant, chokes on a vitamin D tablet, turns purple. Parents saw her go limp and describe a period of apnea, mom gives 5-6 assisted respirations, baby looks well on arrival in ED
2. 6 week old male, asleep in his car seat, dad glanced down at him and noticed him to be bluish and not breathing. Parents give assisted respirations while waiting for EMS. Baby still listless on EMS arrival but vitals stable in ED
3. 3 month old female, referred in to ED because twin sister dies that AM from SIDS. She’s entirely asymptomatic
1. 3 week old infant, chokes on a vitamin D tablet, turns purple. Parents saw her go limp and describe a period of apnea, mom gives 5-6 assisted respirations, baby looks well on arrival in ED
2. 6 week old male, asleep in his car seat, dad glanced down at him and noticed him to be bluish and not breathing. Parents give assisted respirations while waiting for EMS. Baby still listless on EMS arrival but vitals stable in ED
3. 3 month old female, referred in to ED because twin sister dies that AM from SIDS. She’s entirely asymptomatic
DefinitionsDefinitions
ALTE (Apparent Life Threatening Event)
An episode that is frightening to the observer and is characterized by a combination of:
Apnea
Color change
• Marked change in muscle tone
• Choking
• Gagging
ALTE (Apparent Life Threatening Event)
An episode that is frightening to the observer and is characterized by a combination of:
Apnea
Color change
• Marked change in muscle tone
• Choking
• Gagging
DefinitionsDefinitions
SIDS
Sudden death of an infant < 1 year old
Remains unexplained after investigations including
Complete autopsy
Examination of the death scene
A review of the clinical history
SIDS
Sudden death of an infant < 1 year old
Remains unexplained after investigations including
Complete autopsy
Examination of the death scene
A review of the clinical history
SIDS EpidemiologySIDS Epidemiology
95% < 6-8 mo
Peaks 2-4 months
1% < 1 mo, 2% > 2 years
How effective is the “Back to sleep campaign?”
Before: ~ 7000 deaths/year in the U.S. (1.3/1000)
After: ~ 2300 deaths/year in the U.S. (0.57/1000)
95% < 6-8 mo
Peaks 2-4 months
1% < 1 mo, 2% > 2 years
How effective is the “Back to sleep campaign?”
Before: ~ 7000 deaths/year in the U.S. (1.3/1000)
After: ~ 2300 deaths/year in the U.S. (0.57/1000)
Nelson’sNelson’s
SIDS Risk FactorsSIDS Risk Factors
Modifiable
Cigarette smoking
Sleep Environment
Drug and Ethanol Use
Pregnancy Related
Nutritional
Non-Modifiable
Socioeconomic status
• Prematurity
Genetic
Modifiable
Cigarette smoking
Sleep Environment
Drug and Ethanol Use
Pregnancy Related
Nutritional
Non-Modifiable
Socioeconomic status
• Prematurity
Genetic Nelson’sNelson’s
Recurrent SIDS in a SiblingRecurrent SIDS in a Sibling
Idiopathic
CNS Congenital central hypoventilation, Neuromuscular disorders
Cardiac Endocardial fibroelastosis, WPW, prolonged QT, Congenital heart block P
Pulmonary Pulmonary Hypertension
Endocrine/Metabolic
Extensive list - watch for consanguinity
Infection Disorders of immune host defense
Child Abuse Infanticide, Munchausen by proxy
Genetic Risk of death in a twin ~ 2 x the risk
Nelson’sNelson’s
ALTE EpidemiologyALTE Epidemiology
What % of patients who die from SIDS have had a previous ALTE?
7-8%
% of ALTE’s who subsequently die unexpectedly?
10% in ALTE’s occuring during sleep + require CPR
What time do ALTE’s tend to occur?
During Waking hours
At what age do children with ALTE’s present?
2 months on average
Risk Factors for ALTE?
Maternal smoking, single parents, nocturnal diaphoresis
What % are eventually considered idiopathic?
50%
What is the recurrence rate for severe ALTE?
Up to 68% in some studies!
What % of patients who die from SIDS have had a previous ALTE?
7-8%
% of ALTE’s who subsequently die unexpectedly?
10% in ALTE’s occuring during sleep + require CPR
What time do ALTE’s tend to occur?
During Waking hours
At what age do children with ALTE’s present?
2 months on average
Risk Factors for ALTE?
Maternal smoking, single parents, nocturnal diaphoresis
What % are eventually considered idiopathic?
50%
What is the recurrence rate for severe ALTE?
Up to 68% in some studies!
ALTE OutcomesALTE Outcomes
Retrospective cohort
N = 471
Urban setting
Excluded patients with probable etiologies at time of first presentation
5 year ave follow-up (range: 2-7 years)
Retrospective cohort
N = 471
Urban setting
Excluded patients with probable etiologies at time of first presentation
5 year ave follow-up (range: 2-7 years)
Pediatrics 2008; 122(1): 125-31Pediatrics 2008; 122(1): 125-31
ALTE vs SIDSALTE vs SIDS
Common Risk Factor: Smoking during pregnancy
Differences: Most ALTE’s occur in peds < 2 months, compared with a 2-4 month peak for SIDS
52% of ALTE’s occur during wakefulness
SIDS occurs during sleep
No change in ALTE incidence with back to sleep program
Common Risk Factor: Smoking during pregnancy
Differences: Most ALTE’s occur in peds < 2 months, compared with a 2-4 month peak for SIDS
52% of ALTE’s occur during wakefulness
SIDS occurs during sleep
No change in ALTE incidence with back to sleep program
J Pediatr 2009; 154(3): 317-19J Pediatr 2009; 154(3): 317-19
WhIch ALTE’s are At Higher Risk?WhIch ALTE’s are At Higher Risk?
Infants born prematurely
Infants < 43 weeks post-conceptional age
ALTE’s that occur with symptoms of URTI’s
Infants born prematurely
Infants < 43 weeks post-conceptional age
ALTE’s that occur with symptoms of URTI’s
J Pediatr 2009; 154(3): 332-37J Pediatr 2009; 154(3): 332-37
Critical DiagnosisCritical Diagnosis
Bronchiolitis (12%)
Seizures (8%)
Sepsis (7%)
ICH (3%)
Meningitis (2%)
Dehydration (2%)
Anemia (2%)
Bronchiolitis (12%)
Seizures (8%)
Sepsis (7%)
ICH (3%)
Meningitis (2%)
Dehydration (2%)
Anemia (2%) Ann Emerg Med 2004: 43:711-17Ann Emerg Med 2004: 43:711-17
Differential DiagnosisDifferential Diagnosis
ApneaApnea
Most common sign associated with ALTE
Apnea can be normal or pathologic
Various Terms:
Apnea of infancy - unexplained pathologic apneic event occurs for the first time in an infant older than 37 weeks (e.g. unexplained ALTE)
Apnea of prematurity - occurs prior to 37 weeks at which point it resolves
Periodic breathing - three or more resp pauses of greater than 3 seconds duration with less than 20 seconds of respiration between pauses. Common and physiologic in preterm infants. considered pathologic if associated with cardiorespiratory instability
Most common sign associated with ALTE
Apnea can be normal or pathologic
Various Terms:
Apnea of infancy - unexplained pathologic apneic event occurs for the first time in an infant older than 37 weeks (e.g. unexplained ALTE)
Apnea of prematurity - occurs prior to 37 weeks at which point it resolves
Periodic breathing - three or more resp pauses of greater than 3 seconds duration with less than 20 seconds of respiration between pauses. Common and physiologic in preterm infants. considered pathologic if associated with cardiorespiratory instability
Pathologic ApneaPathologic Apnea
no air movement for > 20 seconds* OR
any period of no air movement associated with physiologic compromise (bradycardia, pallor, hypotonia, cyanosis)
Central
No drive from resp centers, neuromuscular insufficiency
e.g. head trauma, Ondine’s curse, apnea of prematurity
Obstructive
Breathing through an occluded airway
e.g. masses, adenotonsillar hypertrophy, OSA, foreign body, laryngomalacia, intralumial cysts
Mixed
Two conditions; e.g. premature infant with central apnea and nasal congestion from URTI,
One condition with features of both; e.g. GERD
no air movement for > 20 seconds* OR
any period of no air movement associated with physiologic compromise (bradycardia, pallor, hypotonia, cyanosis)
Central
No drive from resp centers, neuromuscular insufficiency
e.g. head trauma, Ondine’s curse, apnea of prematurity
Obstructive
Breathing through an occluded airway
e.g. masses, adenotonsillar hypertrophy, OSA, foreign body, laryngomalacia, intralumial cysts
Mixed
Two conditions; e.g. premature infant with central apnea and nasal congestion from URTI,
One condition with features of both; e.g. GERD
InfectionsInfections
One retrospective analysis suggested that SBI’s occurred in close to 3% of well appearing infants presenting with ALTE (risk is higher for premature infants)
Newborns may show little in terms of signs/symptoms of serious bacterial infections so go looking for it!
One retrospective analysis suggested that SBI’s occurred in close to 3% of well appearing infants presenting with ALTE (risk is higher for premature infants)
Newborns may show little in terms of signs/symptoms of serious bacterial infections so go looking for it!
Ped Emerg Care 2009; 25(1):19-25Ped Emerg Care 2009; 25(1):19-25
GERDGERD
One of the most common diagnoses made in the setting of ALTE
Unclear if GERD is purely and associative, responsive, or triggering factor in ALTE’s
One of the most common diagnoses made in the setting of ALTE
Unclear if GERD is purely and associative, responsive, or triggering factor in ALTE’s
J Pediatr 2000; 137(3): 298-300J Pediatr 2000; 137(3): 298-300Ped Clin N Am 2005; 52(4): 1127-46/ Ped Clin N Am 2005; 52(4): 1127-46/
HistoryHistory
Identify central apnea vs obstructive apnea if possible (respiratory pause vs choking, gagging, or gasping)
Try to recreate a technicolor image in your mind what the caregiver saw, what the infant was doing before the event, what happened immediately after, and the infant’s position at the time
Read the EMS report: What did the infant look like when they arrived?
Identify central apnea vs obstructive apnea if possible (respiratory pause vs choking, gagging, or gasping)
Try to recreate a technicolor image in your mind what the caregiver saw, what the infant was doing before the event, what happened immediately after, and the infant’s position at the time
Read the EMS report: What did the infant look like when they arrived?
HistoryHistory
A good feeding history will identify cardiac causes, TEF, and swallowing dysfunction
Ask about snoring, look for obstructions, query about foreign body aspiration
Family history: ask about siblings
A good feeding history will identify cardiac causes, TEF, and swallowing dysfunction
Ask about snoring, look for obstructions, query about foreign body aspiration
Family history: ask about siblings
Physical ExamPhysical Exam
Good CVS, Resp, Abdo, and Neuro Exams
Look for signs of trauma
Don’t miss the fundoscopic exam
Good CVS, Resp, Abdo, and Neuro Exams
Look for signs of trauma
Don’t miss the fundoscopic exam
Investigations Investigations
Basic screening tests
CBC, CH6, ABG, Ammonia level, CXR, ECG
Consider septic work-up
Consider Tox screen
Targeted testing based on history and symptoms
Basic screening tests
CBC, CH6, ABG, Ammonia level, CXR, ECG
Consider septic work-up
Consider Tox screen
Targeted testing based on history and symptoms
CasesCases
1. 3 week old infant, chokes on a vitamin D tablet, turns purple. Parents saw her go limp and describe a period of apnea, mom gives 5-6 assisted respirations, baby looks well on arrival in ED
2. 6 week old male, asleep in his car seat, dad glanced down at him and noticed him to be bluish and not breathing. Parents give assisted respirations while waiting for EMS. Baby still listless on EMS arrival but vitals stable in ED
3. 3 month old female, referred in to ED because twin sister dies that AM from SIDS. She’s entirely asymptomatic
1. 3 week old infant, chokes on a vitamin D tablet, turns purple. Parents saw her go limp and describe a period of apnea, mom gives 5-6 assisted respirations, baby looks well on arrival in ED
2. 6 week old male, asleep in his car seat, dad glanced down at him and noticed him to be bluish and not breathing. Parents give assisted respirations while waiting for EMS. Baby still listless on EMS arrival but vitals stable in ED
3. 3 month old female, referred in to ED because twin sister dies that AM from SIDS. She’s entirely asymptomatic
DispositionDisposition
Choking episodes
Clear choking episodes are not usually life-threatening
Assuming no hx of chronic feeding problems monitor for a few hours, ensure a normal feed occurs, then discharge home
ALTE
If true apnea or significant resuscitation in field most will admit for monitoring (PICU)
Consider septic work-up
Choking episodes
Clear choking episodes are not usually life-threatening
Assuming no hx of chronic feeding problems monitor for a few hours, ensure a normal feed occurs, then discharge home
ALTE
If true apnea or significant resuscitation in field most will admit for monitoring (PICU)
Consider septic work-up
Sids in the EDSids in the ED
Twins of SIDS deaths are admitted for monitoring
Rare that a SIDS death will be brought to ED in active resuscitation
Labs in this case may be helpful for prevention of future siblings
Twins of SIDS deaths are admitted for monitoring
Rare that a SIDS death will be brought to ED in active resuscitation
Labs in this case may be helpful for prevention of future siblings
Minimizing SIDSMinimizing SIDS
Canadian Pediatric Society Recommendations:
Babies should sleep on their back for the first year of life (or until they can turn over on their own)
Firm surface
Soft material out of baby’s sleep environment
Make sure baby is not too warm
Keep baby away from cigarette smoke
No bed sharing
Risk of SIDS with bed sharing is increased if parent has had alcohol, taken any drug with sedating side effects
Canadian Pediatric Society Recommendations:
Babies should sleep on their back for the first year of life (or until they can turn over on their own)
Firm surface
Soft material out of baby’s sleep environment
Make sure baby is not too warm
Keep baby away from cigarette smoke
No bed sharing
Risk of SIDS with bed sharing is increased if parent has had alcohol, taken any drug with sedating side effects
Take-Home PointsTake-Home Points
SIDS and ALTE’s are not the same
ALTE’s are primarily a result of Apnea
Most children with ALTE’s do fine but severe ALTE’s are at higher risk
Although ALTE’s are idiopathic 50% of the time, remember your differential
Think about Sepsis
Think about child abuse
The most important modifiable risk factor for SIDS that we know about is ensuring a safe sleep environment (back to sleep)
SIDS and ALTE’s are not the same
ALTE’s are primarily a result of Apnea
Most children with ALTE’s do fine but severe ALTE’s are at higher risk
Although ALTE’s are idiopathic 50% of the time, remember your differential
Think about Sepsis
Think about child abuse
The most important modifiable risk factor for SIDS that we know about is ensuring a safe sleep environment (back to sleep)
You thought you were having a bad day...You thought you were having a bad day...
...and then it got worse...and then it got worse
PrematurityPrematurityPrematurityPrematurity
PrematurityPrematurity
Definitions
Late preterm - GA greater than 34, less than 37 weeks
Very preterm - GA less than 32 weeks
Low birth weight - Less than 2500g
Very low birth weight - Less than 1500g
Extremely low birth weight - Less than 1000g
Complications with prematurity
RDS 44%
• PDA 30%
BPD 20%
Late onset sepsis 20%
IVH 12%
NEC 7%
Periventricular leukomalacia 5%
Definitions
Late preterm - GA greater than 34, less than 37 weeks
Very preterm - GA less than 32 weeks
Low birth weight - Less than 2500g
Very low birth weight - Less than 1500g
Extremely low birth weight - Less than 1000g
Complications with prematurity
RDS 44%
• PDA 30%
BPD 20%
Late onset sepsis 20%
IVH 12%
NEC 7%
Periventricular leukomalacia 5% www.uptodate.comwww.uptodate.com
CASECASE
16 day old infant presents to the ED with 2-3 days of vomiting. Had been doing well with feedings prior to that. Parents now feel that the vomiting is becoming increasingly forceful
Vomiting becoming dark brown/maroon in color
Last few stools have become darker than usual
No BM, No wet diapers in past 8 hours
No fevers, no sick contacts
Went to WIC yesterday, dx with “overfeeding”
PMHx
born @ 34 weeks gestational age
1 week in NICU requiring phototherapy for hyperbilirubinemia
No pulmonary or cardiovascular issues
16 day old infant presents to the ED with 2-3 days of vomiting. Had been doing well with feedings prior to that. Parents now feel that the vomiting is becoming increasingly forceful
Vomiting becoming dark brown/maroon in color
Last few stools have become darker than usual
No BM, No wet diapers in past 8 hours
No fevers, no sick contacts
Went to WIC yesterday, dx with “overfeeding”
PMHx
born @ 34 weeks gestational age
1 week in NICU requiring phototherapy for hyperbilirubinemia
No pulmonary or cardiovascular issues
Necrotizing Necrotizing enterocolitisenterocolitisNecrotizing Necrotizing enterocolitisenterocolitis
NECNEC
Etiology
Unknown, multifactorial (ischemic/infectious insults/feeding related)
Spectrum of presentation
I - Early or suspected NEC based on feeding intolerance, vomiting, or ileus
II - NEC proven on AXR with abdominal dilation and pneumatosis intestinalis
III - Advanced disease with perforation, metabolic acidosis, DIC, shock
Etiology
Unknown, multifactorial (ischemic/infectious insults/feeding related)
Spectrum of presentation
I - Early or suspected NEC based on feeding intolerance, vomiting, or ileus
II - NEC proven on AXR with abdominal dilation and pneumatosis intestinalis
III - Advanced disease with perforation, metabolic acidosis, DIC, shock
Who’s at Risk?Who’s at Risk?
Prematurity
Low birth-weight
Timing of presentations:
Term infants less than 1 week old
Within first 3 weeks of life in infants born at 29-32 weeks GA
Between 2-4 weeks of life in infants born at 24-28 weeks GA
Prematurity
Low birth-weight
Timing of presentations:
Term infants less than 1 week old
Within first 3 weeks of life in infants born at 29-32 weeks GA
Between 2-4 weeks of life in infants born at 24-28 weeks GA
Clinical PresentationClinical Presentation
May appear well if early or may present in a profound state of shock
Non-specific signs/symptoms
feeding intolerance
blood in vomit or stool
apnea
respiratory distress
abdominal distention
May appear well if early or may present in a profound state of shock
Non-specific signs/symptoms
feeding intolerance
blood in vomit or stool
apnea
respiratory distress
abdominal distention
InvestigationsInvestigations
Labs are non specific but serve as markers of severe disease and follow trends
Thrombocytopenia
Neutropenia
Coagulopathy
CRP
Lactate
Blood Gases
Labs are non specific but serve as markers of severe disease and follow trends
Thrombocytopenia
Neutropenia
Coagulopathy
CRP
Lactate
Blood Gases
X-Ray FindingsX-Ray Findings
Dilated loops of bowel
Air fluid levels
Free air
Pneumatosis intestinalis
Portal venous gas
Dilated loops of bowel
Air fluid levels
Free air
Pneumatosis intestinalis
Portal venous gas
X-Ray FindingsX-Ray Findings
ManagementManagement
Who Needs Surgery?Who Needs Surgery?
Only hard indication is bowel perforation
“Soft” indications:
Radiological signs
persistent fixed loop
portal venous gas
ascites
Lab features
severe acidosis
Only hard indication is bowel perforation
“Soft” indications:
Radiological signs
persistent fixed loop
portal venous gas
ascites
Lab features
severe acidosis
Bronchopulmoary Bronchopulmoary DysplasiaDysplasia
Bronchopulmoary Bronchopulmoary DysplasiaDysplasia
DefinitionDefinition
Often used as a “catchall” term to describe chronic lung disease in the neonatal population
Clinical definition: requiring O2 @ 36 weeks postmenstrual age
Defining who needs supplemental O2 therapy is not black and white and practice varies widely
Often used as a “catchall” term to describe chronic lung disease in the neonatal population
Clinical definition: requiring O2 @ 36 weeks postmenstrual age
Defining who needs supplemental O2 therapy is not black and white and practice varies widely
J Perinat 2008; 28(12): 837-840J Perinat 2008; 28(12): 837-840
PathogenesisPathogenesis
May have severe or mild respiratory diseaseMay have severe or mild respiratory disease
Initially vented with low pressures and FiO2Initially vented with low pressures and FiO2
Honeymoon PeriodHoneymoon Period
After weeks may show progressive deterioration in lung function After weeks may show progressive deterioration in lung function
BPDBPDSem Neonat 2003; 8(1):
63-71
Sem Neonat 2003; 8(1):
63-71
Who is at Risk?Who is at Risk?
Most infants with BPD are born prematurely
75% weigh less than 1 kg at birth
20% of ventilated newborns
Most infants with BPD are born prematurely
75% weigh less than 1 kg at birth
20% of ventilated newborns
Lancet 2006; 367(9520): 1421-31Lancet 2006; 367(9520): 1421-31
Natural HistoryNatural History
Most infants with BPD will show progressive improvement in pulmonary function and wean from supplemental O2 as their lungs grow and remodel
50% of all infants with BPD will need to be readmitted to hospital during early childhood for respiratory distress often exacerbated by RSV
High rate of admission falls during the second year of life
Strong association between BPD and growth retardation and cognitive delays
Most infants with BPD will show progressive improvement in pulmonary function and wean from supplemental O2 as their lungs grow and remodel
50% of all infants with BPD will need to be readmitted to hospital during early childhood for respiratory distress often exacerbated by RSV
High rate of admission falls during the second year of life
Strong association between BPD and growth retardation and cognitive delays
Lancet 2006; 367(9520): 1421-31Lancet 2006; 367(9520): 1421-31
Radiographic FindingsRadiographic Findings
Hyperinflation
Non-homogeneity of pulmonary tissues
Densities extending to the periphery
Diffuse haziness
Hyperinflation
Non-homogeneity of pulmonary tissues
Densities extending to the periphery
Diffuse haziness
Sem Neonat 2003; 8(1): 63-71Sem Neonat 2003; 8(1): 63-71
ManagementManagement
Treat as per asthmatic pathway
Ventolin
Atrovent
Dexamethasone
Treat as per asthmatic pathway
Ventolin
Atrovent
Dexamethasone
www.uptodate.comwww.uptodate.com
Intraventricular Intraventricular HemorrhageHemorrhage
Intraventricular Intraventricular HemorrhageHemorrhage
intraventricular hemorrhageintraventricular hemorrhage
Bleeding originates from the germinal matrix
Occurs most frequently in infants born before 32 weeks or less than 1500g
Virtually all IVH occurs in the first 5 postnatal days
Bleeding originates from the germinal matrix
Occurs most frequently in infants born before 32 weeks or less than 1500g
Virtually all IVH occurs in the first 5 postnatal days
Risk FactorsRisk Factors
Prematurity
Vaginal delivery
Intrapartum asphyxia
RDS
Prolonged neonatal resuscitation
Acidosis
Prematurity
Vaginal delivery
Intrapartum asphyxia
RDS
Prolonged neonatal resuscitation
Acidosis
Clinical PresentationClinical Presentation
Two Types of Presentations:Two Types of Presentations:
DiagnosisDiagnosis
Ultrasound
Routine U/S screening in all infants with GA < 30 weeks
Screening @ 7 & 14 days of age and repeated @ 36-40 weeks post menstrual ages
LP
If no U/S available
Findings similar to SAH
Ultrasound
Routine U/S screening in all infants with GA < 30 weeks
Screening @ 7 & 14 days of age and repeated @ 36-40 weeks post menstrual ages
LP
If no U/S available
Findings similar to SAH
Post-Hemorrhagic HydrocephalusPost-Hemorrhagic Hydrocephalus
35% of infants with IVH
Management
Varies depending on severity
Serial U/S monitoring
Head circumference measurement
Surgery +/- shunt insertion
35% of infants with IVH
Management
Varies depending on severity
Serial U/S monitoring
Head circumference measurement
Surgery +/- shunt insertion
SummarySummary