Snapshot A 2-day-old girl presents for multiple seizure episodes and is admitted to the neonatal intensive care unit. She was born to a 23-year-old woman at 29 weeks gestation via a spontaneous vaginal delivery. On physical exam, there is altered consciousness, hypotonia, a bulging anterior fontanelle, decreased spontaneous movement, and cyanosis. Cranial ultrasonography demonstrates a germinal matrix and intraventricular hemorrhage. Introduction Definition hemorrhage within the germinal matrix and/or ventricles Epidemiology Risk factors prematurity (< 37 weeks) extremely premature infants (28 weeks) are at greatest risk low birth weight (< 1,500 g) Pathogenesis Prematurity does not provide adequate structural support for the germinal matrix this increases the risk of the germinal matrix to hemorrhage Presentation Symptoms seizures altered consciousness Physical exam hypotonia decreased or absent spontaneously or elicited movement bulging anterior fontanelle systemic hypotension Imaging Cranial ultrasonography indication initial imaging modality of choice Differential Periventricular leukomalacia differentiating factors periventricular white matter echodensity and white matter cysts on imaging Treatment Medical phenobarbital indication used in the treatment of seizure in newborns Complications Cerebral palsy Cognitive impairment Neurodevelopmental delay