Investigating the relationship between internal cerebral vein pulsation and the presence and severity of germinal matrix hemorrhage in preterm neonates

Background Intraventricular hemorrhage (IVH) is a major complication in preterm neonates, with increased venous pressure being one of its contributing factors. The internal cerebral vein (ICV) plays a crucial role in draining venous blood from the subependymal germinal matrix, the most common site of IVH onset. Given the importance of identifying and predicting IVH occurrence in neonates, this study aimed to investigate the relationship between pulsations in the internal cerebral vein (ICV-PI) and the development and severity of IVH in preterm neonates born before the 34th week of pregnancy. Methods This study included all neonates born before the 34th week of pregnancy at Taleghani Hospital in Arak, Iran, in 2024. The participants were selected through convenience sampling. The incidence and severity of IVH, along with pulsations in internal cerebral venous flow, were assessed in the enrolled neonates. Evaluations were conducted on the first (24 hours), third (72 hours), and fifth (120 hours) days after birth by a single radiologist via a standardized ultrasound device. Results Eighty-nine preterm neonates were included, 70 of whom developed IVH and 19 of whom did not. Compared with those without IVH, infants with IVH were significantly younger (p = 0.037, Cohen’s d = 0.57, 95% CI: 0.03–1.11). No significant association was found between sex and IVH (p = 0.606). Repeated-measures ANOVA revealed significantly lower ICV-PI values in the IVH group across all time points (p < 0.001) but no significant intragroup differences over time. On Day 1, the ICV-PI in the IVH group was 0.744 ± 0.113, whereas it was 0.854 ± 0.085 in the non-IVH group (p = 0.001). Similar trends were observed on Days 3 and 5 (p < 0.001). The ICV-PI did not significantly differ among IVH severity grades on any of the days (p = 0.817, 0.495, and 0.841 for Days 1, 3, and 5, respectively). No significant association was found between ICV pulsation severity and IVH grade (p = 0.107). Conclusion Preterm neonates who develop IVH have lower ICV-PI values, indicating more pronounced internal cerebral vein pulsations. However, the ICV-PI was not significantly associated with the severity of IVH. These findings suggest that while the ICV-PI may serve as an early indicator of IVH risk, its utility for grading severity remains limited.