In infants with very low birth weights, the risk of IVH is reduced by minimizing fluctuations in blood pressure, while optimizing perfusion through the brain. Antenatal corticosteroids, ethamsylate and low dose indomethacin have been evaluated as preventative agents. After IVH has occurred, the goal of medical therapy is to maintain normal blood pressure and oxygenation. If ventricular size begins to increase, drugs such as acetazolamide and furosemide have been found to control acute ICP changes, but do not alter the need for shunting. A randomized trial examining the role of diamox did not show a beneficial effect.
Figure 1. Coronal ultrasound images demonstrating Grade I (A), II (B), III (C) and IV (D) germinal matrix and intraventricular hemorrhages. The arrows demonstrate the echogenic hematoma in panels A-C. Cystic change in the brain parenchyma is illustrated in panel D (arrow).
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