Intraventricular Hemorrhage (IVH) in Infants
Intraventricular hemorrhage (IVH) is a serious condition caused by bleeding (hemorrhage) in the ventricles. Ventricles are chambers in the brain that hold cerebrospinal fluid (CSF). The fluid circulates from the ventricles into the spinal column. In premature infants, the ventricles are lined with tiny, fragile blood vessels making them more susceptible to IVH. Changes in blood pressure can cause them to bleed (hemorrhage). This is IVH. Blood in the ventricles can keep fluid from circulating normally. If IVH occurs, it’s often within 5 days after birth.
Decreasing the risk of IVH
The best way to decrease IVH is to reduce the number of preterm births. Giving steroids to mothers at risk of early preterm delivery helps reduce the risk of IVH. Getting to a hospital as soon as possible with preterm labor will reduce the risk. Several techniques are used right after delivery to try to reduce the IVH risk.
How is IVH diagnosed?
Ultrasound, a noninvasive imaging test, is used to look at the brain for signs of bleeding. Babies born at less than 32 weeks’ gestation (more than 6 weeks premature) will have a brain ultrasound. If IVH is detected, it is assigned a grade of 1 (mild) to 4 (severe). The grade is based on the amount of bleeding, and whether blood is getting out of the ventricles into the brain tissue.
What are the long-term effects?
The outcome depends on how severe the problem is. Many babies have less severe IVH (grade 1 or 2). These babies will have few or no lasting effects. Babies with more severe disease may have serious complications. These can include neurological damage and developmental delays. Babies with grade 3 IVH may need treatment for fluid buildup in the brain (hydrocephalus). Grade 4 IVH is very likely to cause hydrocephalus, leading to more serious long-term problems. But many babies with grade 3 IVH, and even some with grade 4 IVH, have only minor long-term problems.
What is hydrocephalus?
This condition occurs when fluid becomes trapped in the ventricles. This causes swelling, which puts pressure on the brain tissue. A baby’s skull is soft. This means it can expand. The baby's head circumference may be measured to monitor these changes. The main outward sign of hydrocephalus is that the baby's head gets larger. If swelling continues, pressure on the brain can increase. In some cases, swelling goes down without treatment. But if pressure is not relieved, it can cause brain damage. Treatments for hydrocephalus include:
Lumbar puncture (spinal tap). Draws fluid from the spinal column.
A shunt or a ventricular tap draws fluid directly from the ventricle in the brain.
July 27, 2018
Management and Complications of IVH in the newborn, Up To Date, McCrea, HJ, The Diagnosis, Management and Postnatal Prevention of Intraventricular Hemorrhage in the Preterm Neonate, Clinics in Perinatology (2008); 35(4); pp. 77-792 7
Adler, Liora, MD,Hanrahan, John, MD,Image reviewed by StayWell medical illustration team.