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Intraventricular hemorrhage of the newborn

Definition

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

Alternative Names

IVH - newborn

Causes, incidence, and risk factors

Infants born more than 10 weeks early are at highest risk for this type of bleeding. The smaller and more premature an infant is, the higher the risk for IVH. This is because blood vessels in the brain of premature infants are not yet fully developed. They are very fragile as a result. The blood vessels grow stronger in the last 10 weeks of pregnancy.

IVH is more common in premature babies with:

  • Respiratory distress syndrome
  • Unstable blood pressure
  • Other medical conditions at birth

The problem may also occur in healthy babies who were born early. Rarely, IVH may develop in full-term babies.

IVH is rarely present at birth. It occurs most often in the first several days of life. The condition is rare after 1 month of age, even if the baby was born early.

There are four types of IVH. These are called "grades" and are based on the degree of bleeding.

  • Grades 1 and 2 involve a smaller amount of bleeding. Most of the time, there are no long term problems as a result of the bleeding.
  • Grades 3 and 4 involve more severe bleeding. The blood presses on or leaks into brain tissue. Blood clots can form and block the flow of cerebrospinal fluid. This can lead to increased fluid in the brain (hydrocephalus).

Symptoms

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

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

Signs and tests

All babies born before 30 weeks should have an ultrasound of the head to screen for IVH. The test is done once between 7 and 14 days of age. Babies born between 30-34 weeks may also have ultrasound screening if they have symptoms of the problem.

A second ultrasound may be done when the baby was originally expected to be born (the due date). The test may also be done if a baby has signs or symptoms of IVH.

Treatment

There is no way to stop bleeding associated with IVH. The health care team will try to keep the infant stable and treat any symptoms the baby may be having. 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 drain fluid and try to relieve pressure. If this helps, surgery may be needed to place a tube (shunt) in the brain to drain fluid.

Expectations (prognosis)

How well the infant does depends on the amount of bleeding and if there is brain swelling. Severe bleeding often leads to developmental delays and problems controlling movement. Up to 1 in 5 babies with severe bleeding may die.

Calling your health care provider

Neurological symptoms or fever in a baby with a shunt in place may indicate a blockage or infection. The baby needs to get medical care right away if this happens.

Most newborn intensive care units (NICUs) have a follow-up program to closely monitor babies who have had this condition until they are at least 3 years old.

In many states, babies with IVH also qualify for early intervention (EI) services to help with normal development.

Prevention

Pregnant women who are high risk of delivering early should be given medicines called corticosteroids. These drugs can help reduce the baby's risk for IVH.

Some women who are on medicines that affect bleeding risks should get vitamin K before delivery.

Premature babies whose umbilical cords are not clamped right away have less risk of IVH.

Premature babies who are born in a hospital with a NICU and do not have to be transported after birth also have less risk of IVH.

References

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.

Mercer JS, Vohr BR, McGrath MM, et al, eds. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics. 2006;117(4):1235.

Volpe JJ. Intracranial hemorrhage: germinal matrix-intraventricular hemorrhage. In Volpe JJ, ed. Neurology of the Newborn. 5th edition. Philadelphia, Pa: Saunders Elsevier; 2008:chap 11.


Review Date: 4/26/2013
Reviewed By: Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network.
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