A female infant was born at 31 ⁺⁵ weeks of gestation by spontaneous vaginal delivery in the setting of premature rupture of membranes, preterm labor, and meconium-stained amniotic fluid. Prenatal US was normal. Birth weight was 1780 g. The patient had intermittent apnea requiring positive-pressure ventilation in the first few minutes of birth but did not require prolonged positive-pressure ventilation. Her exam at 3 days of life was appropriate for age with soft, flat fontanelles. At 1 week of life, she developed decreased consciousness, periodic breathing, bulging fontanelles, and rapidly increasing head circumference.

Head US on 1 day after birth was normal. However, US 3 days after birth showed right greater than left intraventricular hemorrhage with ventriculomegaly ( Fig. 9.1 ), which increased at 1-week follow-up ( Fig. 9.2 ). Term equivalent brain magnetic resonance imaging (MRI) showed diffuse hemorrhagic hydrocephalus with evolving porencephalic cyst ( Fig. 9.3 ).

Intraventricular hemorrhage. (A and B) Head ultrasound (US) 3 days after birth with coronal and (C and D) sagittal views show right greater than left intraventricular hemorrhage ( arrows ) with mild ventriculomegaly.

Follow-up intraventricular hemorrhage. (A and B) US 1 week after birth with coronal and (C and D) sagittal views show right greater than left intraventricular hemorrhage with increasing moderate ventriculomegaly.

Posthemorrhagic ventricular dilatation (PHVD). Brain MRI, (A and B) axial T1 and (C and D) sagittal T1 show right intraventricular hemorrhage ( arrows ). There is brain volume loss with enlargement of the ventricles and subarachnoid spaces.