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 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 they will recover.

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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. Bleeding can involve up to 10 percent of the ventricular area. Grade 1 IVH is also called germinal matrix hemorrhage.
  • Grade 2: Bleeding is found in the ventricles and occupies between 10 to 50 percent of the lateral ventricle volume but the ventricles remain the same size.
  • Grade 3: Bleeding is found in the ventricles, and the bleeding occupies more than 50 percent of the lateral ventricle volume and is associated with acute ventricular distension (expansion) related to the volume of blood.
  • Grade 4: Blood is found in the ventricles, and there is infarction (tissue death) of the nearby white matter of the brain. Grade 4 IVH is also called periventricular hemorrhagic infarction (PVHI).

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).


Bleeding occurs because the blood vessels in a premature baby's brain are still very fragile and vulnerable to rupture.

Prematurity is the biggest risk for 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.


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.


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.

Infants with intraventricular hemorrhage may 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.


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.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Afsharkhas L, Khalessi N, Karimi panah M. Intraventricular Hemorrhage in Term Neonates: Sources, Severity and Outcome. Iran J Child Neurol.

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  5. Starr R, Borger J. Periventricular Hemorrhage-Intraventricular Hemorrhage. In: StatPearls. Treasure Island (FL): StatPearls Publishing.

  6. Garton T, Hua Y, Xiang J, Xi G, Keep RF. Challenges for intraventricular hemorrhage research and emerging therapeutic targets. Expert Opin Ther Targets. 2017;21(12):1111-1122. doi:10.1080/14728222.2017.1397628

  7. Tully HM, Dobyns WB. Infantile hydrocephalus: a review of epidemiology, classification and causes. Eur J Med Genet. 2014;57(8):359-68. doi:10.1016/j.ejmg.2014.06.002

  8. Almeida BA, Rios LT, Araujo júnior E, Nardozza LM, Moron AF, Martins MG. Antenatal corticosteroid treatment for the prevention of peri-intraventricular haemorrhage in preterm newborns: a retrospective cohort study using transfontanelle ultrasonography. J Ultrason. 2017;17(69):91-95. doi:10.15557/JoU.2017.0012

Additional Reading
  • Gardner, Marsha. “Outcomes in Children Experiencing Neurologic Insults as Preterm Infants” Pediatric Nursing.

  • Hansen, Thor Willy Ruud. “Prophylaxis of Intraventricular Hemorrhage in Premature Infants: New Potential Tools, New Potential Challenges.” Pediatric Critical Care Medicine.

  • Medline Plus. “Intraventricular Hemorrhage of the Newborn” 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.