Preventing Intraventricular Hemorrhage (IVH) In Preemies

Intraventricular hemorrhage, or IVH, is a complication of premature birth that can be very serious. In IVH, the fragile blood vessels in a preemie's brain start to break or leak, causing bleeding in the ventricles of the brain. IVH can be mild or severe, depending on how much bleeding is present. Mild cases may not have any lasting effects, but severe IVH can cause lifelong physical or mental impairment, and can even be fatal.

Unfortunately, there is no way to stop an IVH once it has begun. Treatments for IVH target the symptoms but can't cure the bleed. The only way to prevent long-term health problems related to IVH is to prevent the bleed itself.

A preemie lying in the NICU.
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Preventing IVH

Because premature babies have very fragile blood vessels in their brains, there is no sure way to prevent all cases of intraventricular hemorrhage. Some preemies, even with the best care, will bleed into their brains. However, there are some medical and nursing interventions that can reduce a baby's chances of developing IVH:

  1. Prevent premature birth: Extreme prematurity is the biggest risk factor for IVH, so preventing prematurity is the best way to prevent IVH. Most bleeds happen in babies born at less than 30 weeks gestation or weighing less than 1500 grams (3 lbs 5 oz). Early and regular prenatal care will help detect any risk factors for premature birth so doctors can plan their treatment appropriately.
  2. Give steroids during pregnancy: Steroids have long been given to pregnant women who are at risk for premature birth to help the baby's lungs to mature faster. Recent studies have shown that, in addition to helping the baby's lungs, steroids during pregnancy can help reduce the baby's risk of IVH.
  3. Utilize developmental care: Most interventions to prevent IVH must be done by the doctors and nurses, but parents play a huge part in helping with developmental care. Maintaining a quiet, dark environment that's as much like the womb as possible is key. Dark blankets over the incubator and plenty of time to sleep and grow in between medical care can help reduce stimulation and prevent IVH. It's natural to want to interact with your baby often, but keeping your interactions short and spaced out in the early days is better for your preemie's development.
  4. Delay umbilical cord clamping: It's common to clamp and cut a baby's umbilical cord immediately after the baby is born. However, new research has shown a number of benefits to waiting at least 30 seconds before clamping the cord, including a reduced risk of IVH.
  5. Monitor blood pressure closely: Low and high blood pressure in the first days of life are both risk factors for intraventricular hemorrhage. It would make sense that using medications to stabilize blood pressure would reduce the risk, but this isn't always the case. Keeping a close eye on the baby's blood pressure and intervening only when absolutely necessary may be a better approach.
  6. Keep heads in a neutral position: Keeping a baby's head in line with the body can help ensure even blood flow to the brain, and may help prevent IVH in the first days of life. Babies may be positioned on their backs, on their tummies, or on their sides, as long as their chin is in line with their umbilical cord.
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  • American College of Obstetricians and Gynecologists. (2012). Timing of umbilical cord clamping after birth. Obstetrics & Gynecology. 120(6): 1522-1526.
  • Bassan, H. (2009). Intracranial hemorrhage in the preterm infant: Understanding it, preventing it. Clinics in Perinatology. 36(4):737-62.
  • Malusky, S. & Donze, A. (2011). Neutral head positioning in premature infants for intraventricular hemorrhage prevention: An evidence-based review. Neonatal Network. 30(6), 381-390.
  • Nist, M., Backes, C., Moorehead, P., & Wispe, J. (2012). Blood pressure support in the very low birth weight infant during the first week of life. Advances in Neonatal Care. 12(3): 158- 163.