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

Full Text:



Paneth N, Pinto-Martin J, Gardiner J, et al. Incidence and timing of germinal matrix/intraventricular hemorrhage in low birth weight infants. Am J Epidemiol 1993; 137(11): 1167-1176.

Volpe JJ. Intracranial hemorrhage: germinal matrix-intraventricular hemorrhage of the premature infant. In Volpe JJ, ed. Neurology of the newborn. 5th ed. Philadelphia, PA: Saunders, 2008: pp 517-588.

Ward R, Beachy J. Neonatal complications following preterm birth. BJOG 2003; 110 (Suppl 20): 8-16.

Stoll BJ, Hansen NI, Bell EF, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126(3): 443-456.

EXPRESS Group. Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatr 2010; 99(7): 978-992.

Lemons JA, Bauer CR, Oh W, et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics 2001; 107(1): E1.

Horbar JD, Carpenter JH, Badger GJ, et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics 2012; 129(6): 1019-1026.

Owens R. Intraventricular hemorrhage in the premature neonate. Neonatal Netw 2005; 24(3): 55-71.

Philip AG, Allan WC, Tito AM, et al. Intraventricular hemorrhage in preterm infants: declining incidence in the 1980s. Pediatrics 1989; 84(5): 797-801.

Klebermass-Schrehof K, Czaba C, Olischar M, et al. Impact of low-grade intraventricular hemorrhage on long-term neurodevelopmental outcome in preterm infants. Childs Nerv Syst 2012; 28(12): 2085-2092.

Volpe JJ. The encephalopathy of prematurity-brain injury and impaired brain development inextricably intertwined. Semin Pediar Neurol 2009; 16(4): 167-178.

Ballabh P. Intraventricular hemorrhage in premature infants: Mechanism of disease. Pediatr Res 2010; 67(1): 1-8.

Blankenberg FG, Loh NN, Norbash AM, et al. Impaired cerebro-vascular autoregulation after hypoxic ischemic injury in extremely low-birth-weight neonates: detection with power pulse wave Doppler US. Radiology 1997; 205(2): 563-568.

Jorch G, Jorch N. Failure of autoregulation of cerebral blood flow in neonates studied by pulsed Doppler US of the internal carotid artery. Eur J Pediatr 1987; 146(5): 468-472.

Lou HC, Lassen NA, Friis-Hansen B. Impaired autoregulation of cerebral blood flow in the distressed newborn infant. J Pediatr 1979; 94(1): 118-121.

Van Bel F, van de Bor M, Stijnen T, et al. Aetiological role of cerebral blood-flow alterations in development and extension of peri-intraventricular haemorrhage. Dev Med Child Neurol 1987; 29(5): 601-614.

Greisen G. Cerebral blood flow in preterm infants during the first week of life. Acta Paediatr Scand 1986; 75(1): 43-51.

Ghazi-Birry JS, Brown WR, Moody DM, et al. Human germinal matrix: venous origin of hemorrhage and vascular characteristics. Am J Neuroradiol 1997; 18(2): 219-229.

Gould SJ, Howard S, Hope PL, et al. Periventricular intraparenchymal cerebral haemorrhage in preterm infants: the role of venous infarction. J Pathology 1987; 151(3): 197-202.

Takashima S, Mito T, Ando Y. Pathogenesis of periventricular white matter hemorrhages in preterm infants. Brain Dev 1986; 8(1): 25-30.

Taylor GA. Effect of germinal matrix hemorrhage on terminal vein position and patency. Pediatr Radiol 1995; 25 Suppl 1: S37-S40.

Bassan H, Feldman HA, Limperopoulos C et al. Periventricular hemorrhagic infarction: risk factors and neonatal outcome. Pediatr Neurol 2006; 35(2): 85-92.

Maller VV, Cohen HL. Neurosonography: Assessing the premature infant. Pediatr Radiol 2017; 47(9): 1031-1045.

Argyropoulou MI, Veyrac C. The rationale for routine cerebral ultrasound in premature infants. Pediatr Radiol 2015; 45(5): 646-650.

Rademaker KJ, Groenendaal F, Jansen GH, et al. Unilateral haemorrhagic parenchymal lesions in the preterm infant: shape, site and prognosis. Acta Paediatr 1994; 83(6): 602-608.

Wong WS, Tsuruda JS, Lierman RL, et al. Color Doppler imaging of intracranial vessels in the neonate. AJR Am J Roentgenol 1989; 152(5): 1065-1070.

Fenton AC, Papathoma E, Evans DH, et al. Neonatal cerebral venous flow velocity measurement using a color flow Doppler system. JCU 1991; 19(2): 69-72.

Taylor GA, Catena LM, Garin DB. Duplex sonography of the neonatal brain. J Diagn Med Sonography 1988; 4(5): 255-261.

Taylor GA. Intracranial venous system in the newborn: Evaluation of normal anatomy and flow characteristics with Color Doppler US. Radiology 1992; 183(2): 449-452.

Winkler P, Helmke K. Duplex-scanning of the deep venous drainage in the evaluation of blood flow velocity of the cerebral vascular system in infants. Pediatr Radiol 1989; 19(2): 79-90.

Schneider A. [Normal values of blood flow velocity in the terminal vein of preterm infants] [Article in German]. Ultraschall in Med 2004; 25(2): 137-140.

Deeg K, Lode H. Trans-fontanellar Doppler sonography of the intracranial veins in infants part i-normal values. Ultraschall Med 2005; 26(6): 507-517.

DOI: http://dx.doi.org/10.36162/hjr.v3i2.221


  • There are currently no refbacks.