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Intraventricular Hemorrhage

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 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).

Anatomy of the brain, showing the ventricles
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What causes IVH?

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 four days of life.

Why is IVH 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 IVH?

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 IVH.

What are the symptoms of IVH?

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.

How is IVH diagnosed?

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 for IVH

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.

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