Intraventricular hemorrhage (IVH) is bleeding inside or around the ventricles in the brain. The ventricles are the spaces in the brain that contain the cerebral spinal fluid. Bleeding in the brain can put pressure on the nerve cells and damage them. Severe damage to cells can lead to brain injury.
IVH is most common in premature babies. There are 4 grades of IVH, depending on the amount of bleeding. They are:
- Grade 1. Bleeding occurs just in a small area of the ventricles.
- Grade 2. Bleeding also occurs inside the ventricles.
- Grade 3. Ventricles are enlarged by the blood.
- Grade 4. Bleeding occurs in the brain tissues around the ventricles.
Grades 1 and 2 are most common. Often the baby has no other complications. Grades 3 and 4 are the most serious. They may result in long-term brain injury to the baby.
It is not clear why IVH occurs. Bleeding can occur because blood vessels in a premature baby’s brain are very fragile and break easily. Nearly all IVH occurs within the first few days of life.
Certain babies are more likely to have IVH. They include:
- Premature babies
- Very-low-birth-weight babies (weighing less than 3 pounds, 5 ounces)
- Babies with breathing problems, such as hyaline membrane disease
- Babies who have other complications of being premature
The following are the most common symptoms of IVH:
- Pauses in breathing (apnea)
- Sow heart rate (bradycardia)
- Pale or blue coloring (cyanosis)
- Weak suck
- High-pitched cry
- Swelling or bulging of the soft spots (fontanelles) between the bones of the baby’s head
- Low red blood cell count (anemia)
The symptoms of IVH may look like other health problems. Make sure your baby sees his or her healthcare provider for a diagnosis.
Your baby’s healthcare provider will ask about your child’s health history and do a physical exam. Your baby will also need a head ultrasound. This test uses sound waves to make a picture of internal structures. The provider can see the inside of the baby’s brain through the fontanelles. With the ultrasound, the amount of bleeding can be graded.
There is no specific treatment for IVH, except to treat any other health problems that may make the condition worse. Your baby may also need supportive care, such as fluids and oxygen.
Sometimes your baby may need surgery to stabilize his or her condition. This may involve surgery to place a tube (shunt) into the baby’s skull to drain the fluid. But this surgery is rarely needed in babies because their skulls are very flexible.
Complications are more likely to occur if a baby has grade 3 or 4 IVH. They may include:
- Development problems
- Too much cerebral spinal fluid in the brain (hydrocephalus)
- Long-term brain injury
Although care of sick and premature babies has advanced greatly, it is not possible to prevent IVH from occurring. But if you are at risk for early delivery, your healthcare provider may give you corticosteroid medicines. This has been shown to lower the risk for IVH in the baby. These steroids are often given to women between 24 and 34 weeks during pregnancy if they are at risk for early delivery.
- IVH is bleeding inside or around the ventricles. The ventricles are the spaces in the brain that contain the cerebral spinal fluid.
- IVH is most likely to occur in premature babies.
- It is not clear why IVH occurs.
- A baby with IVH may have breathing problems and a slow heart rate.
- A head ultrasound can diagnose the condition.
- There is no specific treatment for IVH.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.