Intraventricular Hemorrhage in Newborn

Intraventricular hemorrhage is bleeding in the brain that causes blood to collect in fluid-filled spaces in the brain (ventricles).

This usually happens during the first few days after birth. Intraventricular hemorrhage is more likely to happen in babies that are born too early (prematurely).

Lasting effects of this condition vary depending on how severe the bleeding is, as well as other factors. Mild bleeding often clears up (resolves) on its own or has few long-term effects. Severe bleeding can cause brain damage, which may lead to a condition in which a person experiences slow development and abnormal muscle tone or control (cerebral palsy).

What are the causes?

This condition happens when tiny blood vessels in the brain (capillaries) leak or break open (rupture). A leak or rupture of a capillary may happen because of one or more of the following:

• Being born before having the ability to control blood flow in the brain.
• Being born with genes that increase the risk of bleeding.
• Having problems that cause rapid changes in blood flow and pressure in the brain.
• Having blood that has a lower than normal clotting ability (low platelets).

What increases the risk?

The following factors may make your baby more likely to develop this condition:

• Being born prematurely, especially at 30–32 weeks of pregnancy or less. Earlier deliveries have a higher risk.
• Requiring oxygen at birth as a premature newborn.
• Having unstable blood pressures as a newborn.
• Having an infection as a premature newborn.

What are the signs or symptoms?

Intraventricular hemorrhage does not always cause symptoms. When symptoms are present, they vary depending on how old your baby was at birth (gestational age) and whether your baby is in the immediate or long-term stage of the condition. Symptoms may include:

• Abnormal breathing, or sudden stops in breathing (apnea).
• Pale skin.
• Soft spots on the head (fontanels) that bulge out.
• A shrill or high pitched cry.
• Seizures.
• Difficulty sucking.

In some cases, bleeding causes scarring that prevents fluid in the ventricles from draining properly. This condition causes the baby’s head to get bigger because of too much fluid in the brain (hydrocephalus). Long-term effects of intraventricular hemorrhage may include delays in development or cerebral palsy.

How is this diagnosed?

This condition is diagnosed with a physical exam and a routine imaging test of the head (headultrasound). Your child’s condition will be graded based on how far the bleeding has spread. There are four grades:

• Grade 1. This means the bleeding has stayed in the area where it began.
• Grade 2. This means a small amount of bleeding has spread into the ventricles.
• Grade 3. This means the bleeding has spread into the ventricles and may be making them larger than normal.
• Grade 4. This means the bleeding is inside the brain tissue and there is a very high chance of brain injury.

How is this treated?

Treatment for this condition depends on the amount of bleeding. Mild bleeding usually stops on its own. There is currently no way to stop more serious bleeding. The goal of treatment is to help relieve symptoms. Treatment may include:

• Oxygen to help with breathing.
• Tube feedings.
• Receiving donated blood (blood transfusion).
• Medicines to stop seizures.

In severe cases, if fluid builds up in the brain, your child may need:

• A procedure to remove a small amount of the fluid surrounding the brain (lumbar puncture).
• A surgical procedure to place a drain (shunt) in the brain to drain excess fluid.

Follow these instructions at home:

• Watch your baby closely for breathing problems for as long as told by your baby’s health care provider. A monitor can be used to alert you if your baby suddenly stops breathing (experiences apnea).
• Give your baby over-the-counter and prescription medicines only as told by your baby’s health care provider.
• Keep all follow-up visits as told by your baby’s health care provider. This is important. During these visits, discuss upcoming developmental milestones, such as when your child should start to crawl, walk, and talk.

How is this prevented?

Prior to delivery:

If you are at risk for premature delivery, the risk and severity of intraventricular hemorrhage can be lowered by taking a course of steroid medicines (betamethasone or dexamethasone) before delivery. You can also lower the risk of this condition by having your baby delivered in a hospital that already offers the intensive care your baby would require.

In the neonatal intensive care unit (NICU):

Follow advice from health care providers while your baby is hospitalized. It is important to minimize handling of your baby during the first few days of life, since bleeding is most likely to occur during this time. You should also keep the head of your baby’s bed raised, avoid turning your baby’s head to one side or the other, and reduce noise and light around your baby. Always practice good hygiene before touching your baby, and wash your hands with soap and water after changing a diaper.

Contact a health care provider if:

• Your baby seems to have trouble seeing or hearing.
• Your baby has problems with movements, such as crawling or walking.
• Your child’s movements are very stiff.
• Your baby is 3 months old or older and does not respond to your voice.
• Your baby is 1 year old or older and does not speak or understand any words.

Get help right away if:

• Your baby is struggling to breathe or has sudden stops in breathing (apnea).
• Your baby has a seizure.

Summary

• Intraventricular hemorrhage is bleeding that occurs within the ventricles of the brain.
• Being born too early (prematurely) increases the risk of this condition.
• Intraventricular hemorrhage does not always cause symptoms. A head ultrasound will determine if your baby has this condition and, if so, the level of severity of the condition.
• Be sure to follow the advice from health care providers about caring for your baby while he or she is hospitalized.