What is intraventricular hemorrhage?

Intraventricular hemorrhage (IVH) of the newborn is bleeding into the fluid-filled areas, or ventricles, surrounded by the brain. The condition is most often seen in premature babies, and the smaller and more premature the infant, the higher the risk for IVH. This is because blood vessels in the brain of premature infants are not yet fully developed and are extremely fragile. IVH is rarely present at birth, and if it occurs, it will usually be in the first several days of life.

The condition is quite rare after one month of age, no matter how early the baby was born. But IVH is more common in premature babies who have had physical stress, such as respiratory distress syndrome, pneumothorax or high blood pressure. The condition may also occur in healthy premature babies who were born without injury. IVH may develop in full-term babies, though it is very uncommon.

Symptoms

There may be no symptoms, though the most common symptoms seen in premature infants include:

• Breathing pauses (apnea)
• Decreased muscle tone
• Decreased reflexes
• Excessive sleep
• Lethargy
• Weak suck

Diagnosis

A routine head ultrasound is recommended for all babies born before 30 weeks. The test is done once between seven and 14 days of age. A second routine ultrasound is suggested close to the time the baby was originally expected to be born. IVH should be considered whenever the baby's health worsens suddenly, especially in the first week of life. A head CT is recommended if a term baby has symptoms after a difficult birth, low blood count or other signs of bleeding problems.

Treatment

There is no current therapy to stop the bleeding. The health care team will keep the infant as stable as possible and treat symptoms as appropriate. For example, a blood transfusion may be given to improve blood pressure and blood count. If hydrocephalus develops, a spinal tap may be done to relieve pressure. If the condition cannot be treated with a spinal tap, surgery may be needed to place a tube or shunt in the brain to drain fluid.

Prognosis

How well the infant does depends on the severity of bleeding and whether hydrocephalus develops. Infants with low grades of bleeding have outcomes similar to premature babies who do not have IVH. More severe IVH may lead to developmental delays and movement problems.

Prevention

Pregnant women who are high risk of delivering early may be given corticosteroids to help reduce the baby's risk for IVH. In certain women who are on medications that affect bleeding risks, vitamin K should be given before delivery.