Learn About Intraventricular Hemorrhage of the Newborn
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:
- Respiratory distress syndrome
- Unstable blood pressure
- Other medical conditions at birth
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.
- Grades 1 and 2 involve a smaller amount of bleeding. Most of the time, there are no long-term problems as a result of the bleeding. Grade 1 is also referred to as germinal matrix hemorrhage (GMH).
- Grades 3 and 4 involve more severe bleeding. The blood presses on (grade 3) or directly involves (grade 4) brain tissue. Grade 4 is also called an intraparenchymal hemorrhage. Blood clots can form and block the flow of cerebrospinal fluid. This can lead to increased fluid in the brain (hydrocephalus).
There may be no symptoms. The most common symptoms seen in premature infants include:
- Breathing pauses (apnea)
- Changes in blood pressure and heart rate
- Decreased muscle tone
- Decreased reflexes
- Excessive sleep
- Lethargy
- Weak suck
- Seizures and other abnormal movements
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.
Montefiore Weiler Hospital
Praveen Ballabh, MD, is an attending neonatologist, Professor of Pediatrics and Neuroscientist at Children’s Hospital at Montefiore and Montefiore-Einstein. For more than two decades, Dr. Ballabh’s clinical focus has been in neonatology, working in level IV NICUs. His research is focused on intraventricular hemorrhage (IVH) and he has made major contribution to the field. In fact, he has been one of the known world leaders in the field of IVH research. Dr. Ballabh is rated as an Elite provider by MediFind in the treatment of Intraventricular Hemorrhage of the Newborn. His top areas of expertise are Intraventricular Hemorrhage of the Newborn, Premature Infant, Cerebral Hypoxia, and Gastrostomy.
Cleveland Clinic Main Campus
Hany Aly is a Neonatologist in Cleveland, Ohio. Dr. Aly is rated as an Elite provider by MediFind in the treatment of Intraventricular Hemorrhage of the Newborn. His top areas of expertise are Premature Infant, Intraventricular Hemorrhage of the Newborn, Necrotizing Enterocolitis, Infantile Pneumothorax, and Gastrostomy.
UT Physicians Maternal-Fetal Medicine Center-Memorial City
Hector Mendez is a Neonatologist and an Obstetrics and Gynecologist in Houston, Texas. Dr. Mendez is rated as an Elite provider by MediFind in the treatment of Intraventricular Hemorrhage of the Newborn. His top areas of expertise are Intraventricular Hemorrhage of the Newborn, Necrotizing Enterocolitis, Gestational Diabetes, Salpingo-Oophorectomy, and Hormone Replacement Therapy (HRT).
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 medicines 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.
Summary: Very preterm neonates (born before 32 weeks' gestation) often require invasive mechanical ventilation (IMV) to manage respiratory insufficiency. In France, around 8,250 infants are born annually at \<32 weeks, with an estimated 5,000 needing IMV. Although non-invasive support such as continuous positive airway pressure (CPAP) has become more common, a substantial proportion of these neonates still...
Summary: The purpose of this study is to determine if sequence variations in genes involved in the development and function of vulnerable organs increases susceptibility to chronic lung disease (CLD) and other diseases affecting premature infants, such as necrotizing enterocolitis (NEC), sepsis, patent ductus arteriosus (PDA) and intraventricular hemorrhage (IVH). The study will also determine whether meas...
Published Date: April 05, 2025
Published By: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Dlamini N, deVebar GA. Pediatric stroke. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 641.
Garfinkle J, Miller SP. Neurological problems in the newborn. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 110.