Intraventricular Hemorrhage Symptoms & Causes

What is intraventricular hemorrhage (IVH)?

IVH is bleeding inside or around the ventricles—spaces in the brain that contain the cerebral spinal fluid. Bleeding in the brain can put pressure on the nerve cells and damage them. If the nerve cells are severely damaged, it can result in irreversible brain injury.

IVH is often described in four grades, depending on the amount of bleeding:

  • grade one—bleeding occurs just in a small area of the ventricles
  • grade two—bleeding also occurs inside the ventricles
  • grade three—ventricles are enlarged by the blood
  • grade four—bleeding also occurs in the brain tissues around the ventricles.

Grades one and two are most common and occur in about three-quarters of babies with IVH. Grades three and four are more 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 IVH.

What causes IVH?

It's not clear why IVH occurs but it is thought that it may result from of a lack of oxygen to the brain, due to a difficult or traumatic birth, or from complications after delivery. Bleeding can occur because blood vessels in a premature baby's brain are very fragile and easily rupture. Babies with respiratory problems or other complications of prematurity are more likely to have IVH.

Common symptoms of IVH include:

  • apnea and bradycardia (stopping breathing and low heart rate)
  • pale or blue coloring
  • weak suck
  • high-pitched cry
  • seizures
  • swelling or bulging of the fontanelles, the "soft spots" between the bones of the baby's head
  • anemia (low blood count)