Germinal matrix hemorrhage of prematurity: treatment approaches and outcomes in a single institutional review in the Ukraine

Objective: To review the treatment outcome of germinal matrix hemorrhage (GMH) in premature infants in a single Ukrainian institution in an effort to determine optimal diagnostic and therapeutic approaches.

Materials and methods: Eight hundred and thirty-five premature newborns (gestational age 33.0 +/- 2.50 weeks, birth weight 2,124.81 +/- 282.54 g; mean +/- SD) were examined for the development of perinatal hypoxic-ischemia injury and asphyxia condition. This research focuses on various types of massive intracranial hemorrhage (ICH) and posthemorrhagic hydrocephalus (PHH). The diagnostic methods were based on intracranial imaging studies and clinical features that are present at birth. The therapeutic and preventive strategies consist of parental counseling, supportive and rehabilitative care for affected infants. Surgical intervention was indicated for the prevention and treatment of severe PHH. Thirty-four preterm infants were treated by ventricular-peritoneal/subgaleal shunting with close monitoring of intracerebral pressure.

Results: Massive GMH took place at 32-35 gestational weeks as a result of increased periventricular anastomosis. GMH was unusual in full-term newborns, whereas cerebral hypoxic-ischemic injuries were more common in full-term neonates. Approximately 98% of premature infants with low birth weight survived and 2% died due to respiratory distress syndrome and other complications. ICH which occurs in neonates at 24-28 gestational weeks was mainly due to immature vascular walls and insufficiency of vascular anastomosis at the germinal matrix.

Conclusions: ICH occurring in the germinal matrix of premature newborns is closely related to the development of the brain vasculature. Evacuation of the hematoma is more detrimental than beneficial, despite the rapid strides being taken to keep low-birth weight premature infants alive. Therefore, the treatment of ICH and PHH requires a fundamental understanding of pathogenetic changes, which is necessary for the neurorehabilitation and immediate elimination of cerebral compression and its complications.