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Intraventricular Hemorrhage of Infancy by Alexandra Howson, PhD

Definition

Intraventricular hemorrhage (IVH) occurs when small blood vessels burst and bleed into the ventricles of a baby’s brain. The ventricles are spaces in the brain. These spaces are full of cerebrospinal fluid (CSF). In most cases, the bleeding gradually stops. The blood vessels heal themselves. Surgery may not be needed. If brain tissue is damaged, the baby may have long-term problems with development. IVH is most common in premature babies.

Ventricles of the Brain

Causes

It is often not clear why IVH occurs. Changes in blood pressure in the baby’s brain may cause immature or fragile blood vessels to rupture (burst). This may occur during the first 48 hours after birth.

Risk Factors

These factors increase your baby’s chance of developing IVH:

Prematurity
Low birth weight
Lack of oxygen
Direct trauma to the baby’s head during birth (eg, pressure caused by hip bone, forceps, or vacuum)
Breathing complications at birth
Infection that leads to blood clotting problems

Symptoms

In many cases, there are no visible signs of IVH. If your baby has any of the following symptoms, do not assume it is due to IVH. These symptoms may be caused by other conditions. The hospital staff will examine your baby to see if he has:

Swelling of fontanelles at the top of the head (soft spots between the bones of the skull)
Apnea (pauses in breathing)
Seizures
Muscle spasms
Pale or blue color
Weak suck

Diagnosis

The doctor will do a physical exam of your infant. The doctor will look for any signs of injury in the brain. The following tests may be used:

Ultrasound—a test that uses sound waves to examine the baby’s head to look for burst blood vessels and bleeding; often used to make the diagnosis
Other tests (eg, blood tests to check for anemia, metabolic acidosis, infection)

Treatment

Talk with your doctor about the best treatment plan for your baby. Treatment options include the following:

Monitoring your baby’s condition to make sure it remains stable
Treating any other medical conditions
Having procedures done—If too much fluid builds up in the brain, it can cause damage to the brain. Examples of procedures that may need to be done include:
- Lumbar puncture , fontanelle tap, or surgery—to drain fluid from your baby's brain
- Ventriculoperitoneal shunt—a tube that runs from the ventricle, under the skin, and into the baby's abdomen to drains fluid from the brain

Prevention

It is not possible to prevent IVH, but there are some steps that can be taken:

If you are at risk of having a premature baby, your doctor may prescribe medicines to decrease the chance of IVH. You may have an injection of steroids to reduce the risk of IVH.
If you are pregnant, be sure that you go to all of your prenatal appointments.

RESOURCES:

American Academy of Neurology http://www.aan.com/
American Academy of Pediatrics http://www.aap.org/

CANADIAN RESOURCES:

Canadian Pediatric Society http://www.cps.ca/
Health Canada http://www.hc-sc.gc.ca/index_e.html/

References:

Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res. 2010;67(1):1-8.
Children’s Hospital Boston. Intraventricular hemorrhage. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site1185/mainpageS1185P0.html . Accessed April 20, 2010.
Cunningham FG, Leveno KJ, Bloom SL, et al. Diseases and injuries of the fetus and newborn. In: Obstetrics . 23rd ed. New York, NY: McGraw-Hill Books; 2010:605-645.
DynaMed Editorial Team. Intraventricular hemorrhage in infancy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated December 29, 2009. Accessed April 20, 2010.
Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database of Systematic Reviews. 2010;7.
Hill A. Intraventricular hemorrhage in the term newborn. In Bradley WG, Daroff RB, Fenichel G, Jankovic J. Neurology in Clinical Practice . 5th ed. Burlington, MA: Butterworth-Heinemann; 2008.

Last reviewed June 2012 by Rimas Lukas, MD

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