How is intraventricular hemorrhage (IVH) graded in neonates, and what imaging modality is commonly used for diagnosis?

• A. IVH graded I–IV by severity; bedside cranial ultrasound is commonly used, MRI providing detailed evaluation if needed.
• B. IVH graded A-D; CT scan only.
• C. IVH graded 1-2; MRI only.
• D. IVH not graded; ultrasound not used.

Answer: (D)

Intraventricular hemorrhage in newborns is classified using a four-tier grading system that describes how far the bleed extends: Grade I is confined to the germinal matrix, Grade II shows blood within the ventricles without ventricular enlargement, Grade III involves intraventricular blood with ventricular dilation, and Grade IV includes hemorrhage that extends into the brain parenchyma. This grading helps clinicians gauge severity and prognosis and guide management.

For diagnosis and monitoring in the NICU, bedside cranial ultrasound is the go-to imaging modality because it is safe, can be performed at the bedside, and allows repeated exams to track progression or hydrocephalus without moving the infant. MRI provides the most detail and is used when more information is needed, while CT is not preferred for routine evaluation due to radiation exposure.