Brain
Intraventricular haemorrhage grading
Grades germinal matrix and intraventricular haemorrhage on cranial ultrasound (Papile grades I to IV).
For education. Check against your unit's guidance and a second clinician before use.
Use the table below. Grading is done on cranial ultrasound, usually reported by a senior or radiologist. Repeat scans follow your unit's schedule.
Papile grading of intraventricular haemorrhage
| Grade | Cranial ultrasound findings |
|---|---|
| I | Bleeding confined to the germinal matrix (subependymal) |
| II | Bleeding into the ventricle, without ventricular dilatation |
| III | Bleeding into the ventricle, with ventricular dilatation |
| IV | Bleeding into the brain tissue next to the ventricle (periventricular haemorrhagic infarction) |
How this is calculated
- Papile grading by extent of bleeding and ventricular size. Grade IV is now usually described as periventricular haemorrhagic infarction (bleeding into the brain tissue next to the ventricle), a separate process from the ventricular bleed.
Sources
Checked by NICUlearn, 6 Oct 2026.