Terminal veins and neonatal intraventricular haemorrhage of prematurity: a sonographic approach

Marina Vakaki, Efthymia Alexopoulou, Rodanthi Sfakiotaki, Argyro Mazioti, Dimitrios Lambrou, Anna Hountala, Chrysoula Koumanidou


Purpose: To evaluate the sonographic appearance and velocities of terminal veins (TVs) in premature neonates without/with germinal matrix (GMH) or intraventricular haemorrhage (IVH), and to investigate for an early sonographic finding, helpful in the prognosis of IVH.

Material and Methods: Two groups of premature babies (24-36 gestational weeks) were prospectively studied. Group I included 60 neonates without haemorrhage and Group II 40 neonates with GMH/IVH.  TVs were evaluated for their presence, type of flow, time-averaged maximum (Tmax) and time-averaged mean (Tmean) velocity by colour and pulsed Doppler. 

Results: In Group I, 117 out of 120 TVs (97.5%) were visualised, with continuous, monophasic flow pattern. Statistical analysis of Tmax and Tmean velocities documented that both increased in a linear association with gestational weeks. Tmax velocities ranged from 2.04 cm/sec (24 gestational weeks) to 4.63 cm/sec (36 gestational weeks); Tmean velocities ranged from 1.16 cm/sec to 2.81 cm/sec, respectively. In Group II, 14 GMHs, 33 IVHs Grade II, 17 IVHs Grade III and 4 parenchymal haemorrhagic infarcts (PHIs) were demonstrated. One large GMH, two IVHs Grade II and one IVH Grade III with no flow in the ipsilateral TV progressed to PHI. In 4 more PHIs already developed in the initial sonogram, no TV flow was demonstrated.

Conclusions:  TVs can be sonographically visualised in almost all prematures. When a GMH-IVH has occurred, TV demonstration represents a good prognostic sign for the haemorrhage evolution. In contrary, no TV flow seems to be a bad prognostic sign preceding the PHI appearance.


terminal vein; intraventricular haemorrhage; premature neonate; ultrasonography; Doppler

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