History of the patient can be entirely noncontributory in periventricular hemorrhageintraventricular hemorrhage (PVH-IVH). Caregivers or parents might note nonspecific subtle signs. However, in some patients, events that result in loss of autoregulation of cerebral blood flow can be obtained.Physical The presentation of PVH-IVH widely varies. Most infants are asymptomatic or demonstrate subtle signs that are easily overlooked. PVH-IVH subsequently is found on surveillance sonography. One subgroup of infants with PVH-IVH presents with the following: A sudden unexplained drop in hematocrit levels Possible physical findings related to anemia (eg, pallor, poor perfusion) or hemorrhagic shock Another subgroup of infants with PVH-IVH presents with extreme signs. A sudden and significant deterioration associated with anemia,metabolic acidosis, glucose instability,respiratory acidosis, apnea, hypotonia, and stupor is present. Physical findings related to these signs include poor perfusion, pallor or an ashen color, irregularities of respiratory pattern, signs of respiratory distress including retractions and tachypnea, hypotonia, and altered mental status (eg, decreased responsiveness, coma). Additional neurological signs, such as fullness of the fontanels, seizures, and posturing, may also be observed. Progression can be rapid and may result in shock and death. Between the 2 extremes of presentation, infants might demonstrate varying degrees of neurological and systemic signs. Those with symptoms are more likely to have a more serious grade of PVH-IVH.CausesPrematurity is the most important risk factor for PVH. However, other factors have been associated with the development of hemorrhage. Rapid volume expansion (eg, the correction of hypotension with volume infusions) Asynchrony between mechanically delivered and spontaneous breaths in infants on ventilation Hypertensionor beat-to-beat variability of blood pressure Coagulopathy Hypoxic-ischemic insults Respiratory disturbances (eg, hypercarbia, hypocarbia pneumothorax, hypoxemia, rapid alterations in blood gasses) Acidosis Infusions of hypertonic solutions (eg, sodium bicarbonate) Anemia Vacuum-assisted delivery Frequent handling Tracheal suctioning