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Intraventricular Hemorrhage

Conditions

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Intraventricular hemorrhage (IVH) is bleeding inside or around the ventricles, the spaces in the brain containing the cerebral spinal fluid.

  • Intraventricular means within the ventricles
  • Hemorrhage means excessive bleeding

Intraventricular hemorrhage is most common in premature babies, especially very low birthweight babies weighing less than 1,500 grams (3 pounds, 5 ounces). The smaller and more premature the baby, the more likely IVH will occur. It is possible, although less likely, for babies born full term to have IVH. 

IVH can lead to the death in brain cells near the bleeding. IVH can also cause increased pressure in the head (hydrocephalus) which, if severe, could be life-threatening.

Patients can be seen by Texas Children's experts in Neurology.

Causes & Risk Factors

Several factors (and usually a combination of these factors) are involved in the development of IVH. One of the many factors is the fact that blood vessels in a premature baby's brain are not yet fully matured and are at increased risk of rupture, leading to IVH. Babies with respiratory problems are more likely to have IVH. Full term babies in a hypercoagulable state (too much clotting of the blood) are at risk for IVH.

Symptoms & Types

The following are the most common symptoms of intraventricular hemorrhage (IVH). However, each baby may experience symptoms differently. Symptoms may include:

  • Apnea and bradycardia (stopping breathing and low heart rate)
  • Pale or blue coloring (cyanosis)
  • 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)

The symptoms of IVH may resemble other conditions or medical problems. Always consult your baby's doctor for a diagnosis.

What are the different grades of intraventricular hemorrhage?

The amount of bleeding varies. IVH is often described in 4 grades:

  • Grade 1. Bleeding occurs just in a small area of the ventricles.
  • Grade 2. Bleeding occurs in a larger area inside the ventricles.
  • Grade 3. Ventricles are enlarged by the blood.
  • IVH and apparent periventricular hemorrhagic infarction. Bleeding into the ventricles and bleeding and cell death seen in the area near the ventricles.

Grades 1 and 2 are most common, and often there are no further complications. Grades 3 and IVH with apparent periventricular hemorrhagic infarction are the most serious and may result in long-term brain injury to the baby.

Diagnosis & Tests

In addition to a complete medical history and a physical examination, 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 & Care

No specific therapy exists to limit the extent of IVH after it has occurred. The treatment for IVH is generally supportive and involves maintenance of adequate blood pressure, adequate oxygenation and ventilation, and providing appropriate fluid and nutritional support.  Sometimes, surgery is necessary to stabilize the condition of the baby. This may 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.