An Overview of Intraventricular Hemorrhage (IVH) in Preemies

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An intraventricular hemorrhage, also called IVH, is bleeding into the ventricles of the brain. An IVH can be mild or severe, depending on how much bleeding there is. Some babies who experience an IVH won't have any long-term effects, while babies with more extensive bleeds might have developmental delays or other lasting effects.

If your baby has been diagnosed with intraventricular hemorrhage, learning as much as you can about this condition can help you to understand what is going on with your baby and how he or she will recover.

Symptoms

Babies suffering from mild hemorrhages may not have any symptoms. Symptoms of more severe intraventricular hemorrhages in premature babies include:

  • Increased episodes of apnea and bradycardia
  • Decreased muscle tone
  • Decreased reflexes
  • Weak suck
  • Excessive sleep

In infants, intraventricular hemorrhages are categorized by how severe the hemorrhage is.

  • Grade 1: Bleeding is limited to the germinal matrix, a fragile area near the ventricles that contains many small capillaries. Grade 1 IVH is also called germinal matrix hemorrhage.
  • Grade 2: Bleeding is found in the ventricles, but the ventricles remain the same size.
  • Grade 3: Bleeding is found in the ventricles, and the bleeding has caused the ventricles to dilate, or grow larger.
  • Grade 4: Blood is found in the ventricles, which have dilated, and in nearby areas of the brain. Grade 4 IVH is also called intracranial hemorrhage.

Infants with a grade 1 to 2 bleed may have no lasting effects. Those with grade 3 to 4 IVH may experience developmental delays, poor cognitive function, and an increased risk of attention deficit-hyperactivity disorder (ADHD).

Causes

It's not clear why IVH occurs, but it is thought that it may result from a difficult or traumatic birth or from complications after delivery. Bleeding occurs because the blood vessels in a premature baby's brain are still very fragile and vulnerable to rupture.

Prematurity is the greatest cause of intraventricular hemorrhage, and most cases of IVH occur in babies less than 30 weeks gestation or under 1,500 grams (3 pounds, 5 ounces).

Doctors think that several things combine to make preemies susceptible to IVH. Beyond the fragility of blood vessels, premature babies also may suffer from repeated episodes of low blood-oxygen levels and exposure to greater fluctuations in blood pressure.

Intraventricular hemorrhages tend to happen early in life, with 90% occurring within the first three days following birth.

Diagnosis

Intraventricular hemorrhages are diagnosed with an ultrasound of the head. Many hospitals routinely screen all premature babies for IVH within the first week of life and again before hospital discharge.

Treatment

Unfortunately, there is no way to stop an intraventricular hemorrhage once it has begun. Treatment for IVH targets symptoms of the bleed and may include increased respiratory support or medications for apnea and bradycardia.

Up to 10% of infants with intraventricular hemorrhage will develop hydrocephalus, a buildup of cerebrospinal fluid in the ventricles (fluid-containing cavities) of the brain.

Hydrocephalus, also known as "water on the brain," causes cranial swelling and places pressure on delicate brain tissue. Hydrocephalus may go away on its own, or surgery may be required. If needed, the doctor may insert a ventriculoperitoneal shunt (VP shunt) to drain the fluid and reduce pressure on the brain.

Prevention

Because IVH can cause severe complications and cannot be stopped once it has begun, doctors and scientists have focused their efforts on prevention. Preventing preterm delivery is the best way to prevent IVH, so expectant mothers with risks for preterm delivery should talk to their doctors about lowering their risk.

Several medications have been studied for their role in preventing IVH. Antenatal steroids in women who are at risk for an early delivery have been shown to give some protection, but must be given in a narrow time window. Another medication, indomethacin, has also been shown to give some protection.

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Article Sources

  • Gardner, Marsha. “Outcomes in Children Experiencing Neurologic Insults as Preterm Infants” Pediatric Nursing Nov/Dec 2005: 31; 448-457.
  • Hansen, Thor Willy Ruud. “Prophylaxis of Intraventricular Hemorrhage in Premature Infants: New Potential Tools, New Potential Challenges.” Pediatric Critical Care Medicine Jan. 2006: 7; 90-92.
  • Medline Plus. “Intraventricular Hemorrhage of the Newborn” Accessed 8-20-09 from the website.
  • Sears MD, William, Sears MD, Robert, Sears MD, James, Sears RN, Martha. The Premature Baby Book: Everything You Need to Know About Your Premature Baby from Birth to Age One. Little, Brown and Co., New York, 2004.