Head Ultrasound Scans
Detection of Germinal Matrix-Intraventricular Haemorrhage and Periventricular Leukomalacia


Reviewed by Carl Kuschel
Clinical Guidelines Back Newborn Services Home Page
Associated Risk Factors Timing of IVH Diagnosis
Indications for USS Grading System Other Information

Intracranial haemorrhage (ICH) can affect newborns of all gestational ages and often is clinically ‘silent’. Germinal matrix haemorrhage and intraventricular haemorrhage (GM-IVH) is most common in the premature population.

Estimates of frequency have changed over the last 20 years. Currently, large series report a 15% prevalence in infants <32 weeks.

National Women's data for the period 2001-2003 indicates an incidence of 10.0% for GM-IVH in infants<32 weeks.  Those most at risk were infants <28 weeks gestation.  Grade 3 and 4 GM-IVH was seen in 2.9% of infants<32 weeks, with a higher incidence (15.5%) in infants <26 weeks gestation.

The incidence of periventricular leukomalacia (PVLM) in infants <32 weeks at National Women's over the same period of time was 1%.

Routine screening for GM-IVH is performed in infants <30 weeks or <1250g at birth.

Associated Risk Factors

  • SGA status of newborn
  • Maternal pre-eclampsia
  • Asphyxia
  • Male gender
  • Outborn infant
  • Antepartum haemorrhage
  • Base deficit >10

Timing of IVH


Indications for Cerebral Ultrasound Scan

Grading Systems


I Germinal layer (subependymal haemorrhage)
II Intraventricular haemorrhage - no dilatation (<97th percentile)
III Intraventricular haemorrhage with dilatation
IV Intraparenchymal haemorrhage

Periventricular Leucomalacia

without cysts  echogenic periventricular margins (flare)
cystic multiple small periventricular cysts
porencephaly large intraparenchymal cysts

Other Information