Classification of intracranial haemorrhage in premature infants.

The most common classification of intracranial haemorrhage in premature infants into four degrees of severity is based on the results of CT-scans. However, this classification does not adequately account for some pathophysiological and morphological changes. For this reason, the paediatric section of DEGUM developed a new method of classification. This classification distinguishes more precisely between the bleeding itself and secondary changes, such as posthaemorrhagic Ventricular dilation, which were excluded from the revised classification. The new system contains three revels: Grade I: subependymal haemorrhage, grade II: intraventricular haemorrhages taking up < 50% of the ventricular volume, grade III: intraventricular haemorrhages of > 50% of Ventricular volume. Areas of increased echo levels within the brain tissue (formerly grade IV) which are caused by haemorrhagic infarction are now taken as a separate entity. The morphological description lists the side and the location of-the haemorrhagic infarction as well as its size, which is classified into 'small' (less than or equal to 1 cm in diameter), 'medium' (1 less than or equal to 2 cm) and large (> 2 cm). Bleeding into the basal ganglia, cerebellum and brainstem are separate entities. In post-haemorrhagic Ventricular dilation the distinction is made between self-limiting transient dilation and hydrocephalus requiring treatment.