Intraventricular hemorrhage of the newborn is a condition where there is bleeding in the brain’s ventricles, the areas of the brain filled with cerebrospinal fluid (CSF) (1). Intraventricular hemorrhage or IVH is seen most often in preterm babies. Babies born earlier in gestation with low birth weight are more likely to develop IVH.
IVH is rare during birth and most common in the first few days of a newborn (2). When bleeding occurs in the brain, there is huge pressure on nerve cells that could cause potential damage, leading to a brain injury (3).
Explore more on the risk factors, causes, symptoms, diagnoses, treatment, and preventive measures for IVH in babies.
Causes And Risk Factors Of IVH In Babies
The exact cause of IVH in babies is unknown. However, the bleeding may occur because a premature baby’s blood vessels are fragile and may rupture easily (4).
- Premature birth
- Very low birth weight (birth weight lesser than 3.5 pounds or 1.5kg)
- Insufficient or lack of oxygen supply to the brain due to difficult or traumatic delivery
- Complications during delivery
- Respiratory problems
- Genetic anomalies or birth defects
- Blood clotting problems
- Prenatal infection
- Maternal high blood pressure
Some babies may develop IVH without showing any risk factors. Shaken baby syndrome and head injury could be risk factors for IVH in healthy newborns and older babies.
Different Grades Of IVH
IVH is graded into four categories based on the severity and extent of bleeding in the brain (1).
- Grade one: Bleeding occurs in a small area/section of the ventricles.
- Grade two: Bleeding occurs inside the ventricles.
- Grade three: Ventricles enlarge due to the accumulated blood.
- Grade four: Bleeding gets around the ventricles and into the brain tissue.
Grade one and two are most common and most often do not lead to any complications. Grade three and four may lead to long-term brain injury and complications, such as infection and hydrocephalus.
Signs Of IVH In Babies
- Apnea (pauses in breathing)
- Blood pressure fluctuations
- Reduced muscle tone
- Poor reflexes
- Lethargy and excess sleepiness
- Bradycardia (slow heart rate)
- Pale or bluish skin discoloration (cyanosis)
- Weak sucking
- High-pitched cry
- Bulging fontanelles (soft spots)
- Abnormal eye movement
- Stupor and coma in severe cases
Diagnosis Of IVH
The baby’s healthcare provider will assess the detailed medical history, including maternal prenatal medical history, and examine the symptoms. The easiest and non-invasive method of diagnosing IVH is by doing a a head ultrasound. An ultrasound uses sound waves to take pictures of the internal structures of the baby’s brain.
Premature babies born at 30 weeks or earlier may have an ultrasound screening for IVH. Babies born between 30-34 weeks may be advised an ultrasound if they show IVH symptoms. The healthcare provider may suggest multiple ultrasounds based on the findings of previous ultrasounds and in order to evaluate progression or development of complications due to the IVH (4) (5).
Treatment For IVH In Babies
There is no specific treatment for IVH in babies except treating the complications and keeping the baby stable. Blood transfusions may be performed to improve blood count and blood pressure. Oxygen and fluid support may also be provided.
If there is fluid accumulation in the brain, the doctors may perform a spinal tap to drain the cerebrospinal fluid and relieve the pressure (5). However, surgery is rarely needed because babies’ skulls are flexible and can tolerate some extra fluid (4).
About 90% of IVH cases are mild in babies and resolve with little or no problems. The body absorbs the blood in mild cases, and the follow-up head ultrasounds turn out normal. Babies who recover develop similar to any other baby without IVH (6).
Prognosis Of IVH In Babies
The prognosis depends on how premature the baby was at birth and the severity of the hemorrhage. It also depends on the presence of complications, such as hydrocephalus. IVH is fatal in up to one-third of babies with severe bleeding (5).
Babies with low grades of IVH have similar outcomes as babies without IVH (2). Babies with higher grades of IVH may experience complications and their effects, such as developmental delays and motor problems. Such babies may require long-term monitoring to detect developmental problems early.
Prevention Of IVH In Babies
- Pregnant women at a high risk of premature delivery should be administered corticosteroids between weeks 24 and 34. It may help reduce the baby’s risk of developing IVH.
- Women on medications that may cause bleeding problems should be administered supplemental vitamin K before delivery to help with better blood clotting.
- Umbilical cords of premature infants should not be clamped immediately; it may help in reducing the risk of IVH development.
- Deliveries of premature babies should be planned in hospitals with NICU facilities. Immediate access to NICU could lower the risk of IVH.
Frequently Asked Questions
1. Does IVH cause cerebral palsy?
Yes, IVH may increase the risk of cerebral palsy. Premature infants with grades III and IV of IVH show a 60% probability of developing cognitive disorders such as cerebral palsy and mental retardation (7).
2. How common is IVH in preemies?
Intraventricular hemorrhage (IVH) has been found to affect around 15% to 20 % of babies born before 32 weeks of pregnancy (7).
Premature or low-birth-weight newborns are more likely to experience intraventricular hemorrhage. Unfortunately, nearly one-third of all babies born with IVH do not survive; however, babies born with low-grade IVH recover entirely and have no long-term issues. Since it is more common in preterm babies, if you are at risk of preterm labor, do not hesitate to discuss the probability of IVH in your baby with your healthcare provider.
- Preterm birth, a traumatic or delivery with complications, may increase the risk of intraventricular hemorrhage in newborns.
- A slow heart rate, seizures, bulging fontanelles, or apnea are a few signs of this condition.
- An IVH in babies can be diagnosed after a head ultrasound.
2. Intraventricular Hemorrhage; Johns Hopkins medicine
3. Intraventricular Hemorrhage; Children’s Hospital of Philadelphia
4. Intraventricular Hemorrhage in Babies; University of Rochester Medical Center
5. Intraventricular hemorrhage of the newbornn; U.S. National Library of Medicine
6. Intraventricular hemorrhage in premature babies; Children’s Minnesota
7. Dawid Szpecht et al. Intraventricular hemorrhage in neonates born before 32 weeks of gestation—retrospective analysis of risk factors; NCBI