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).
IVH - newborn; GMH-IVH
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:
The problem may also occur in otherwise 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 the first 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.
There may be no symptoms. The most common symptoms seen in premature infants include:
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 fluid builds up to the point that there is concern about pressure on the brain, 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.
How well the infant does depends on how premature the baby is and the grade of the hemorrhage. Less than half of babies with lower-grade bleeding have long-term problems. However, severe bleeding often leads to developmental delays and problems controlling movement. Up to one third of babies with severe bleeding may die.
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.
Pregnant women who are at 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 for 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 for IVH.
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Dlamini N, deVebar GA. Pediatric stroke. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 619.
Soul JS, Ment LR. Injury to the developing preterm brain: intraventricular hemorrhage and white matter injury. In: Swaiman KF, Ashwal S, Ferriero DM, et al, eds. Swaiman's Pediatric Neurology. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 22.