Intraventricular hemorrhage (IVH) is when there is bleeding in or around the ventricles of the brain. This condition is most common in premature babies (though versions of this occur in all age groups). IVH can put pressure on nerves in the brain and cause injury and permanent damage.
When Does an Intraventricular Hemorrhage Happen?
This condition not usually present at birth, but rather occurs within the first three to four days after birth. It is important to understand the signs and measures to take if a baby may be suffering from it.
For infants born before 30 weeks or ones who weigh less than 5 lb 3 oz, it is always a good idea to ask for an ultrasound in the days following birth. This is one of the most effective ways of finding out if a baby is experiencing IVH. After 1 month out of the womb, there is almost no further risk of IVH.
Grades of Intraventricular Hemorrhages
Grades I-IV:
- Grade I – Bleeding of the ventricles in small areas (also known as germinal matrix hemorrhage)
- Grade II – There is bleeding found inside the ventricles
- Grade III – The blood is causing an enlargement of the ventricles and presses on the brain tissue
- Grade IV – Blood is found in the brain tissues surrounding the ventricles (also known as an intraparenchymal hemorrhage).
Grades 1 and 2 are the most common and refer to smaller amounts of bleeding. Generally, a grade 1 or 2 hemorrhage will not cause permanent damage and can be treated.
Grades 3 and 4 are diagnosed when such severe bleeding has entered the ventricles that they are enlarged and blood clots could be preventing the flow of cerebrospinal fluid. This increases the amount of fluid in the brain, otherwise known as hydrocephalus.
Causes:
There is no easily definable cause of intraventricular hemorrhage. The condition occurs because blood vessels are not fully developed or strong enough to support the blood flow (which is why this is rarely found in more developed babies).
While it could be caused by a head injury or pressure from delivery, it can also occur without much warning or reason.
Many factors can contribute to the likelihood of this condition. Premature babies are most at risk, especially those born ten weeks early or earlier. The more premature a baby is, the more at risk he or she is for this and other health complications.
Preemies born with respiratory problems (like RDS) or other complications because of prematurity are also at higher risk. Babies who experience other blood-related problems, infections, and/or shaken baby syndrome have an increased risk of intraventricular hemorrhage.
Symptoms”
Sometimes, babies with intraventricular hemorrhage may experience little to no obvious symptoms. In other cases, there are various symptoms that may occur.
Because many of these symptoms could also be indicative of other conditions, it is important to consult with a doctor when you notice any of the following:
- Apnea, or trouble breathing
- Decreased or slow reflexes
- Lethargy or baby is sleeping abnormally extended periods of time/often
- Changes in heart rate
- Weak suck during breastfeeding
- Seizures
- High-pitched crying
- Pale or blue coloring of the skin
- Decreased muscle tone
While none of these symptoms are a sure sign of intraventricular hemorrhage, they could all point to a serious problem and should be brought to the attention of a medical professional.
An ultrasound of the head and blood tests can determine whether a baby is suffering from intraventricular hemorrhage and at what grade.
Ultrasounds can also assist in determining if the baby may be suffering from another condition or complication.
Common Treatments:
There is no natural cure for intraventricular hemorrhage, but there are steps doctors and mothers can take to help prevent or lessen the effects of the condition.
Mothers with a high risk of premature delivery may be prescribed certain steroids to reduce the risk of a premature baby developing it.
If it is discovered that the baby is suffering from intraventricular hemorrhage, doctors can try to lessen symptoms and stabilize the baby to prevent more damage while it heals. In more extreme cases, surgery can be used to try to stabilize the baby’s condition. Before surgery, doctors may drain the cerebrospinal fluid with a needle or through less invasive surgery to relieve pressure on the ventricles.
Generally, babies with less severe grades will heal on their own; however, medical assistance can give them the best chance to recover with no or minimal damage.
The Prognosis of intraventricular hemorrhage:
The outcome depends on the severity of intraventricular hemorrhage and how premature the baby is when it develops this. The more developed a baby is, the less its risk. Most babies who suffer grade 1 or 2 will survive, and with minimal damage. Less than about a third of babies with grade 3 or 4 die because of it or may suffer severe long-term damage.
If treated properly and caught early on though, the prognosis of most cases can be very promising.
Intraventricular hemorrhage prevention tips:
It’s hard to prevent intraventricular hemorrhage, aside from certain medications that can lessen risk and, of course, providing excellent care to premature babies.
Other factors that can help decrease the chance include:
- Giving birth in a hospital with a NICU (so babies can be more quickly treated and with minimal movement)
- Delayed cord clamping or umbilical cord milking
- Taking vitamin K before delivery (especially for women who may take medications that alter blood flow and increase bleeding risks)
If your baby is premature or you were particularly worried about this condition, speak to your doctor to see what measures can be taken to help prevent and treat intraventricular hemorrhage.
Compiled using information from the following sources:
1. NIH.gov. U.S. National Library of Medicine. “Intraventricular hemorrhage of the newborn”
2. StanfordChildrens.org. Standford Medicine. “Intraventricular Hemorrhage”
3. CerebralPalsy.org.“Intraventricular Hemorrhage, Or IVH”
4. URMC.Rochester.edu The University of Rochester Medical Center: Health Encyclopedia. “Intraventricular Hemorrhage”
5. Boston Children’s Hospital: Intraventricular Hemorrhage.
