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Acta Paediatr. 2007 Sep;96(9):1257-8.

A different view: there is value in grading intraventricular hemorrhage.

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Department of Clinical Science, University of Bristol, Bristol, United Kingdom.


The traditional 1-4 grading system for intra-ventricular haemorrhage (IVH) has been criticized on several points. Grade 1 IVH is not really intra-ventricular at all but all neurosonographers have recognized this for many years. Grade 3 IVH is criticized as it includes ventricular dilatation but grade 3 IVH is a haemorrhage large enough to distend the ventricle with blood not cerebrospinal fluid (CSF). The distinction between small and large IVH is valuable as the prognosis is very different. Grade 4 IVH is criticized as it is not an 'extension' but authors have described this as parenchymal haemorrhagic infarction for decades. Grade 4 IVH has different risk factors, prognosis and prophylaxis from periventricular leucomalacia. The shorthand category of 'severe IVH', meaning grades 3 and 4, is not adequate for individual patient assessment but is certainly useful for annual statistics, comparisons over time and between hospitals.


Despite limitations, grading IVH has value.

[Indexed for MEDLINE]

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