Intraventricular Hemorrhage (IVH)

Intraventricular hemorrhage (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 most common in premature babies, especially babies weighing less than three pounds, five ounces.
• Nearly all IVH occurs within the first three days of life.
• It's not clear why IVH occurs.

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.

Common symptoms 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)

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.

Your child's doctor may recommend a cranial ultrasound, which uses sound waves to create a picture, to diagnose IVH and measure the amount of bleeding.

Unfortunately, there's 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's not possible to prevent IVH from occurring. However, giving medications (called corticosteroids) to mothers who are at risk of early 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.