Which statement correctly defines Grade 4 IVH?

• A. IVH with intraparenchymal hemorrhage
• B. IVH with ventricular dilation
• C. IVH without dilation
• D. Subependymal hemorrhage along the ventricle

Answer: (A)

Grade 4 IVH is defined by intraventricular hemorrhage with extension into the brain parenchyma. In the neonatal Papile grading system, this means the hemorrhage has spread from the ventricles into the surrounding brain tissue (intraparenchymal involvement). This distinguishes it from grades II and III, which involve the ventricles without and with dilation, respectively, and from grade I, which is confined to the germinal matrix/subependymal area without ventricular or parenchymal extension. Therefore, the statement describing IVH with intraparenchymal hemorrhage best matches grade 4.