Intraventricular hemorrhage (IVH) of the newborn is bleeding into the fluid-filled areas (ventricles) inside the brain. The condition is most often seen in premature babies.

IVH - newborn

Infants born before 30 weeks of pregnancy are at highest risk for such bleeding. The smaller and more premature the infant, the higher the risk for IVH. This is because blood vessels in the brain of premature infants are not yet fully developed and are extremely fragile. The blood vessels grow stronger after 30 weeks of pregnancy.

IVH is more common in premature babies who have had respiratory distress syndrome, high blood pressure, and other conditions. The condition may also occur in healthy premature babies who were born without injury. IVH may develop in full-term babies, but this is very uncommon.

IVH is rarely present at birth. If it occurs, it will usually be in the first several days of life. The condition is quite rare after 1 month of age, no matter how early the baby was born.

IVH falls into four groups, called grades. The higher the grade, the more severe the bleeding.

Grades 1 and 2 involve a small amount of bleeding and do not usually cause long-term problems.

Grades 3 and 4 involve more severe bleeding, which presses on or leaks into brain tissue. Blood clots can form and block the flow of cerebrospinal fluid, leading to increased fluid in the brain (hydrocephalus).

There may be no symptoms. The most common symptoms seen in premature infants may include:

• Breathing pauses (apnea)
• Changes in blood pressure and heart rate
• Decreased muscle tone
• Decreased reflexes
• Excessive sleep
• Lethargy
• Weak suck

An ultrasound of the head is recommended for all babies before 30 weeks to screen for IVH. The test is done once between 7 and 14 days of age.

A second ultrasound is suggested close to when the baby was originally expected to be born. The test may also be done if your child has signs or symptoms of IVH.

A CT scan of the head is recommended if a baby has symptoms after a difficult birth, low blood count, or signs of bleeding problems.

Currently, there is no way to stop bleeding associated with IVH. The health care team will keep the infant as stable as possible, and treat symptoms as appropriate. For example, a blood transfusion may be given to improve blood pressure and blood count.

If swelling on the brain develops, a spinal tap may be done to relieve pressure. If this cannot be done, surgery may be needed to place a tube or shunt in the brain to drain fluid.

How well the infant does depends on the amount of bleeding and if there is brain swelling. Severe bleeding may lead to developmental delays and problems controlling movement.

Regular doctor's visits are recommended for several years after being diagnosed with an IVH. The doctor will check the child's developmental and make sure the bleeding has not damaged the brain.

Pregnant women who are high risk of delivering early may be given medicines called corticosteroids to help reduce the baby's risk for IVH.

In certain women who are on medications that affect bleeding risks, vitamin K should be given before delivery.

Bassan H. Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol. 2009 Dec;36(4):737-62, v.

Ment LR. Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. Jun 2002; 58(12): 1726-38.