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) login to view 1 more bullet 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 login to view 1 more bullet Differential Periventricular leukomalacia differentiating factors login to view 1 more bullet Treatment Medical phenobarbital login to view 2 more bullets Complications Cerebral palsy Cognitive impairment Neurodevelopmental delay