What Is IVH?
An intraventricular hemorrhage is a severe medical condition where blood vessels in the brain rupture.
The blood from the ruptured blood vessels then flows into the ventricles, or hollow parts of the brain that hold cerebrospinal fluid (CSF). As blood fills the ventricles, it puts pressure on otherwise healthy brain cells, potentially causing long-term or permanent brain damage.
Some neonates (newborn babies) fully recover from a neonatal intraventricular hemorrhage. However, if the brain damage is severe, not all babies will. Some newborns may even develop cerebral palsy or other incurable neurological conditions due to their IVH.
IVH is most common in premature babies, so expectant mothers at risk of preterm delivery should be closely monitored by their health care teams.
Intraventricular Hemorrhage Grades
Medical professionals classify intraventricular hemorrhages using four grades, which are based on the amount of bleeding within the brain.
- Grade 1: Blood is present in only a small area of the ventricles
- Grade 2: Blood is present inside the ventricles
- Grade 3: Blood causes the ventricles to become enlarged
- Grade 4: Blood seeps into the brain tissues in and around the ventricles
Usually, a grade 1 or 2 IVH does not present any long-term health risks, as the blood is relatively contained.
A grade 3 or 4 IVH is more severe, with serious bleeding that places pressure directly on the newborn’s brain tissue. This can result in blood clotting or blocking the flow of cerebrospinal fluid. When additional fluid accumulates where it shouldn’t, it can lead to a rare brain condition called hydrocephalus.
Intraventricular Hemorrhage Causes
Doctors are still researching all potential causes of IVH. Blood vessels are relatively fragile up until the last 10 weeks of pregnancy, which explains why premature babies are at higher risk.
In full-term infants, however, IVH may be caused by untreated health problems in the mother or mistakes made during delivery.
For example, if a mother suffers from untreated high blood pressure or an infection during pregnancy, IVH may occur in the baby. Additionally, the use of forceps or vacuum extractors during delivery can also cause head trauma that leads to a hemorrhage.
Talk to your doctor before delivery if you are concerned about the possible causes of an IVH. Make sure your doctor has a plan to safely deliver your child if complications do occur.
Who Is at Risk?
Infant IVH almost always occurs within a few days after birth. The more premature an infant is, the higher the risk of intraventricular hemorrhage. Once an infant reaches one month of age, the risk significantly drops.
Other risk factors include:
- Breathing or respiratory problems in the infant
- Blood clotting issues in the infant
- A difficult labor
- Genetic history
- Low birth weight
Finally, babies who experience blunt trauma to the head or shaken baby syndrome may also develop IVH.
Intraventricular Hemorrhage Symptoms
Common symptoms of IVH include:
- Changes in blood pressure
- Decreased muscle tone
- Excessive amounts of sleep
- High-pitched cry
- Pale or blue coloring
- Reduced heart rate and reflexes
- Sleep apnea
- Weak suck
- Swollen fontanelles (soft spots between the bones of the baby’s head)
IVH symptoms may be mistaken for another type of brain injury, or there may not be noticeable symptoms at all. If you notice that your newborn is displaying any of the symptoms listed above, reach out to your postnatal care team.
Conditions Related To Intraventricular Hemorrhages
IVH is just one type of intracranial hemorrhage — conditions defined by bleeding within the brain. Below, learn more about other types of hemorrhages that are closely related to IVH.
Like IVH, a periventricular hemorrhage (PVH) occurs when blood vessels burst and start to flood the ventricular system. With PVH, however, blood stays on the outside of the ventricle lining versus entering the ventricles themselves.
Doctors often group PVHs and IVHs under one category since the conditions are so similar.
A severe IVH or PVH affects the parts of the brain that send nerve signals to the muscles, putting babies who develop a hemorrhage at risk of cerebral palsy. If blood damages these brain pathways, the child can lose control over the muscles in their limbs.
An intracerebral hemorrhage is a type of stroke that occurs when the brain itself starts to bleed. It causes blood to clot inside the brain potentially leading to brain cell damage, paralysis, and other life-threatening health conditions.
In a subdural hemorrhage, also known as a subdural hematoma, the blood vessels between the skull and the brain burst. This causes blood to collect on the dura mater, a protective layer that separates the brain from the skull.
In severe cases, the blood can push on the brain itself, potentially causing permanent brain damage or even death without treatment.
A subarachnoid hemorrhage occurs when blood fills the cavity between the arachnoid membrane and the brain, irritating healthy brain cells and preventing oxygen from reaching the brain. This type of hemorrhage is very dangerous — only one-third of those affected make a full recovery.
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Intraventricular Hemorrhage Diagnosis
Diagnostic tests can help determine if a child is suffering from an IVH or another type of hemorrhage. The most commonly used test is an ultrasound, which uses sound waves to create images.
Medical experts recommend a routine head ultrasound for:
- All babies born before 30 weeks gestation
- Full-term babies showing any IVH symptoms
The ultrasound is usually performed when the infant is between seven and 14 days old. Doctors may also perform another ultrasound for premature babies shortly after they are born. Ultrasound images can be used to determine the IVH grade of bleeding.
If an infant’s health suddenly deteriorates within the first week of life, or if symptoms of IVH emerge, doctors may perform a follow-up magnetic resonance imaging (MRI) scan on the baby’s head. MRIs use a series of magnetic waves to get an in-depth look at the brain.
Intraventricular Hemorrhage Treatment
There are no specific treatments to stop the bleeding associated with IVH at this time.
For this reason, doctors and expectant mothers should take proactive measures to prevent future harm to the baby. A notable step is to provide medications for women at risk of premature delivery, as IVHs are more common in premature babies.
If a hemorrhage does occur, doctors will work to stabilize the baby and treat symptoms.
Procedures to help treat symptoms may include:
- Blood transfusion
- Spinal taps
- Use of a shunt system (catheter with valves) to drain brain fluid
Health care providers can also provide oxygen and fluids or treat other health conditions, such as hydrocephalus, that could make IVH complications worse.
Intraventricular Hemorrhage Prognosis
IVH grade plays a big role in a baby’s prognosis, or expected health outcome. Less than 50% of babies with a low-grade IVH have long-term health problems.
Johns Hopkins Medicine also states that newborns with mild IVHs have “outcomes similar” to other babies born prematurely with no signs of IVH.
However, higher IVH grade bleeding may leave babies with:
- Long-term brain injuries
- Significant developmental delays
- Problems with motor skills
- Cerebral palsy
As many as 33% of babies with severe IVHs pass away, according to the U.S National Library of Medicine.
Can You Prevent an Intraventricular Hemorrhage?
Unfortunately, there is no way to stop an IVH once it has begun. The only way to stop it is to prevent it from occurring in the first place.
The U.S. National Institutes of Health (NIH) recommend that women experiencing high-risk pregnancies be given corticosteroid medications to reduce the baby’s IVH risk. This is often done between 24 and 34 weeks gestation.
Other preventative recommendations include:
- Women on medications that introduce bleeding risks should be given vitamin K before delivery.
- Doctors should avoid immediately clamping the umbilical cord of a premature baby.
- Health care providers should ensure premature babies are born in a hospital with the proper neonatal facilities, like an intensive care unit. This way, the baby won’t have to travel to another hospital if emergency care is needed.
Doctors, midwives, and other medical staff should be proactive with pregnancies that are high-risk or when treating women who show signs of premature delivery. Careful monitoring during pregnancy, birth, and delivery can help reduce the risk factors for an IVH.
Avoiding IVHs While Pregnant
If you have recently become pregnant, talk with your doctor to learn more about preventing an IVH or other birth injuries. Make sure your medical team has the skill and experience needed to handle any complications that may come up.
Also, keep in mind that your health care team has a duty to keep you and your baby safe. If your delivery does not go smoothly — and your child suffers long-term health problems due to an IVH — your doctors may be responsible.
Learn more about holding medical teams accountable for birth injuries with a free case review.