Intraventricular Hemorrhage in Babies

What is IVH in babies?

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.

What causes intraventricular hemorrhage in a 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.

Which babies are at risk for intraventricular hemorrhage?

Certain babies are more likely to have IVH. A baby is at risk with any of these:

• Preterm birth
• Very low birth weight (weighing less than 3 pounds, 5 ounces)
• Breathing problems, such as hyaline membrane disease
• Mother who had labor and delivery problems
• Genetic background
• Abusive head trauma (AHT), which may also be called shaken baby syndrome
• Head injury
• Mother with an infection
• Mother with high blood pressure
• Blood clotting problems

What are the symptoms of IVH in a baby?

These are the most common symptoms of IVH:

• Pauses in breathing (apnea)
• Slow heart rate (bradycardia)
• Pale or blue coloring (cyanosis)
• Weak sucking
• High-pitched cry
• Seizures
• Lethargy, stupor, or coma
• Swelling or bulging of the soft spots (fontanelles) between the bones of the baby’s head
• Low red blood cell count (anemia)
• Decreased reflexes
• Decreased muscle tone
• Abnormal eye movement

The symptoms of IVH may look like other health problems. Take your baby to their healthcare provider for a diagnosis.

How is IVH diagnosed in a baby?

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.

How is IVH treated in a baby?

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 a baby may need surgery to stabilize their condition. This may involve surgery to place a tube (shunt) into the baby’s brain to drain the fluid most commonly into the belly (abdomen). But this surgery is rarely needed in babies because their skulls are very flexible and can handle a small amount of extra fluid.

What are possible complications of IVH in a baby?

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
• Death

How can I help prevent IVH in my baby?

Although care of sick and preterm 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 of pregnancy if they are at risk for early delivery.

Key points about IVH in babies

• 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 other than supportive care and possible surgery.

Next steps

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 and when they should be reported.
• 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 healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.