Health Library

Intraventricular hemorrhage (IVH) is bleeding in the brain. The blood collects in spaces called ventricles, which are filled with fluid. This normally happens in the first few days after birth, especially in babies born too early (prematurely).

How IVH affects a baby depends on how much bleeding there is and what else is going on with the baby's health.

a. Mild bleeding often gets better on its own and has few long-term effects.

b. Severe bleeding can damage the brain and may lead to problems like:

1. Trouble with movement or muscle control (cerebral palsy).
2. Seizures.
3. Developmental delays.

What are the causes?

IVH happens when tiny blood vessels in the brain break or leak. This can happen because of:

1. Health problems passed down from parents (inherited) that make bleeding more likely.
2. Quick changes in blood flow or pressure in the brain.
3. Trouble with how your baby's blood clots.

What increases the risk?

IVH is more common in babies who:

1. Were born before 37 weeks, especially before 32 weeks.
2. Weighed very little at birth.
3. Needed help breathing with oxygen or a machine called a ventilator.
4. Had low or changing blood pressure or an infection.
5. Had a hard or long birth.

What are the signs or symptoms?

Some babies don't show any symptoms. If there are symptoms, they may include:

1. Pale skin and low levels of red blood cells (anemia).
2. Breathing problems or sudden stops in breathing.
3. Sudden change in heart rate or oxygen levels.
4. Low blood pressure.
5. Seizures or shaking that can't be controlled.
6. A soft spot on the head (fontanel) that gets wider or bulges.

If bleeding blocks fluid from draining, the head may get bigger. This is called hydrocephalus. This can stop the brain from growing right.

How is this diagnosed?

IVH is diagnosed with:

1. A physical exam.
2. An ultrasound or MRI of the baby's head.

IVH is graded based on how far the bleeding has spread. There are four grades:

1. Grade 1 – Bleeding stays in the area where it started.
2. Grade 2 – A small amount of bleeding spreads into the ventricles.
3. Grade 3 – More bleeding spreads into the ventricles and makes them larger than normal.
4. Grade 4 – Bleeding spreads into the brain tissue around the ventricles and greatly raises the risk of brain injury.

How is this treated?

Treatment for IVH depends on how much bleeding there is:

a.     Mild bleeding may stop on its own.

b.     Severe bleeding may need:

1. Oxygen to help your baby breathe.
2. Blood (blood transfusion) through an IV.
3. Medicine to stop seizures.

If fluid builds up in the brain, your baby may need:

1. Surgery to place a small tube (reservoir or shunt) in the brain to drain extra fluid.
2. A procedure to remove extra fluid around the brain.
3. Another ultrasound or MRI to see if the bleeding is getting worse.

In the hospital unit for newborns (NICU), the health care team will:

1. Watch your baby's condition closely.
2. Keep the area quiet and dim to help your baby stay calm.
3. Give vitamin K to help prevent bleeding.
4. Give medicines to help prevent serious bleeding in premature babies.
5. Safely touch and hold your baby, especially during the first few days when bleeding is most likely.

Follow these instructions at home:

1. Watch your baby's breathing.
2. Give your child medicines only as told.
3. Keep all follow-up visits to check your baby's head growth and development.

Contact a health care provider if:

1. Your baby seems to have trouble seeing or hearing.
2. Your baby has problems with movements, such as crawling or walking.
3. Your baby's movements are very stiff.
4. Your baby doesn't respond to your voice by 3 months.
5. Your baby doesn't say or understand words by 1 year.