What is intraventricular hemorrhage (IVH)?
Intraventricular hemorrhage (IVH) is bleeding inside or around the ventricles, the
spaces in the brain containing the cerebral spinal fluid.
Intraventricular hemorrhage is most common in premature babies, especially very low
birthweight babies weighing less than 1,500 grams (3 pounds, 5 ounces).
What causes intraventricular hemorrhage?
It is not clear why IVH occurs. Bleeding can occur because blood vessels in a premature
baby's brain are very fragile and immature and easily rupture. Babies with respiratory
problems, such as hyaline membrane disease, or other complications of prematurity,
are more likely to have IVH. The smaller and more premature the baby, the more likely
IVH will occur. Nearly all IVH occurs within the first few days of life.
Why is intraventricular hemorrhage a concern?
Bleeding in the brain can put pressure on the nerve cells and damage them. Severe
damage to cells can lead to brain injury.
What are the different grades of intraventricular hemorrhage?
The amount of bleeding varies. IVH is often described in four grades:
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 into the brain tissues around the ventricles.
Grades 1 and 2 are most common, and often there are no further complications. Grades
3 and 4 are the most serious and may result in long-term brain injury to the baby.
Hydrocephalus (too much cerebral spinal fluid in the brain) may develop after severe
What are the symptoms of intraventricular hemorrhage?
The following are the most common symptoms of intraventricular hemorrhage (IVH):
Apnea and bradycardia (stopping breathing and low heart rate)
Pale or blue coloring (cyanosis)
Swelling or bulging of the fontanelles, the "soft spots" between the bones of the
Anemia (low blood count)
The symptoms of IVH may look like other conditions or medical problems. Always consult
your baby's doctor for a diagnosis.
How is intraventricular hemorrhage diagnosed?
In addition to a complete medical history and a physical exam, a cranial (head) ultrasound
is usually used to diagnose IVH. This test uses sound waves to create a picture of
internal structures. A cranial ultrasound can view the inside of the baby's brain
through the fontanelles, the spaces between the bones of the baby's head. With the
ultrasound, the amount of bleeding can be graded.
Treatment for intraventricular hemorrhage
There is no specific treatment for IVH, except to treat any other health problems
that may worsen the condition. Although care of sick and premature babies has advanced
greatly, it is not possible to prevent IVH from occurring. However, giving the mother
corticosteroid medications before delivery has been shown to lower the risk of IVH
in the baby. These steroids are often given to women between 24 and 34 weeks gestation
who are at risk of early delivery. Sometimes, surgery is necessary to stabilize the
condition of the baby. This may occasionally involve placement of a catheter into
the baby's skull, although this is rarely necessary in babies because of the flexibility
of their skull bones.