# Papile — Papile grading of germinal matrix and intraventricular hemorrhage

> Grades germinal matrix and intraventricular hemorrhage in neonates.

**Situação:** vigente · **Órgão:** Pediatria · **Órgão emissor:** Neonatal imaging consensus · **Versão:** 1978 · **Ano:** 1978

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: US
- Fonte primária: Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage (Papile) (1978) — https://doi.org/10.1016/s0022-3476(78)80282-0
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| I | Grade I | Hemorrhage limited to the germinal matrix (subependymal), without extension into the ventricle. | Supportive neonatal care; serial cranial ultrasound surveillance is advised (roughly weekly for about four weeks and again at discharge) with head-circumference monitoring; no CSF diversion needed in the absence of ventricular dilatation. | Low-grade injury but not benign: cerebral palsy reported in roughly 7-8% at 2 years corrected age, and neurodevelopmental delay, hearing loss and CP can still occur. | Criteria: StatPearls NBK538310, Introduction. Management/risk: Inan/Karadag review (PMC7536465) — CP ~6.8% in grade I, weekly US surveillance for grades I-II. | ✓ |
| II | Grade II | Intraventricular hemorrhage occupying less than 50% of the ventricular area, without ventricular dilatation. | Supportive care with serial cranial ultrasound (about weekly for four weeks and at discharge) and head-circumference tracking; intervention reserved for any progressive ventricular dilatation. | Cerebral palsy reported in about 8% at 2 years, rising to ~12% when accompanied by ventricular dilatation or cystic/echodense periventricular leukomalacia. | Criteria: StatPearls NBK538310, Introduction. Management/risk: PMC7536465 — CP ~8.1% (12.2% with ventricular dilatation/PVL); weekly US surveillance for grades I-II. | ✓ |
| III | Grade III | Intraventricular hemorrhage with ventricular dilatation, the blood occupying more than 50% of the ventricle. | Closer cranial ultrasound surveillance (about twice weekly until discharge); for progressive post-hemorrhagic ventricular dilatation, temporizing CSF measures (ventricular reservoir or ventriculosubgaleal shunt) precede permanent ventriculoperitoneal shunting once the infant reaches ~2-2.5 kg. | Severe (grade III/IV) IVH: post-hemorrhagic hydrocephalus develops in roughly a third of very-low-birth-weight infants with IVH; cerebral palsy exceeds 50% and ~75% need special education in grade III-IV. | Criteria: StatPearls NBK538310, Introduction. Management/risk: PMC7536465 — twice-weekly US, reservoir/subgaleal shunt then VP shunt; PHH in ~1/3, CP >50% and special education ~75% in grade III-IV. | ✓ |
| IV | Grade IV | Intraventricular hemorrhage accompanied by intraparenchymal (periventricular) hemorrhage; previously termed Grade IV, now also called periventricular hemorrhagic infarction (PVHI). | Intensive cranial ultrasound surveillance (about twice weekly until discharge); progressive PHVD managed with temporizing CSF drainage (reservoir/ventriculosubgaleal shunt) and later permanent VP shunting; supportive care with seizure management. | Worst prognosis: roughly 30-40% die; severe neurodevelopmental disorder in ~55% (rising to ~86% with PVHI plus shunt); reported cerebral palsy ~60%, cognitive problems ~50%, visual field defects ~25%, epilepsy ~20%. | Criteria: StatPearls NBK538310, Introduction. Management/risk: PMC7536465 — mortality ~30-40%, severe NDD ~55% (86% with PVHI+shunt), CP ~60%, cognitive ~50%, visual defects ~25%, epilepsy ~20%. | ✓ |

### Citações por categoria
- **I**: Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage (Papile) (1978) — https://doi.org/10.1016/s0022-3476(78)80282-0 · Criteria: StatPearls NBK538310, Introduction. Management/risk: Inan/Karadag review (PMC7536465) — CP ~6.8% in grade I, weekly US surveillance for grades I-II.
- **II**: Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage (Papile) (1978) — https://doi.org/10.1016/s0022-3476(78)80282-0 · Criteria: StatPearls NBK538310, Introduction. Management/risk: PMC7536465 — CP ~8.1% (12.2% with ventricular dilatation/PVL); weekly US surveillance for grades I-II.
- **III**: Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage (Papile) (1978) — https://doi.org/10.1016/s0022-3476(78)80282-0 · Criteria: StatPearls NBK538310, Introduction. Management/risk: PMC7536465 — twice-weekly US, reservoir/subgaleal shunt then VP shunt; PHH in ~1/3, CP >50% and special education ~75% in grade III-IV.
- **IV**: Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage (Papile) (1978) — https://doi.org/10.1016/s0022-3476(78)80282-0 · Criteria: StatPearls NBK538310, Introduction. Management/risk: PMC7536465 — mortality ~30-40%, severe NDD ~55% (86% with PVHI+shunt), CP ~60%, cognitive ~50%, visual defects ~25%, epilepsy ~20%.


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