The clinical presentation is diverse, and diagnosis requires neuroimaging for confirmation. Signs may mimic those of other ICH or common neonatal disorders such as metabolic disturbances, asphyxia, sepsis, or meningitis. IVH may be totally asymptomatic, or there may be subtle symptoms, for example, a bulging fontanel, a sudden drop in hematocrit, apnea, bradycardia, acidosis, seizures, changes in muscle tone, or changes in level of consciousness. A catastrophic syndrome may accompany an extensive IVH. It is characterized by a precipitous fall of hematocrit, a rapid onset of stupor or coma, respiratory failure, seizures, decerebrate posturing or a profound flaccid quadriparesis, and fixed pupils