Intraventricular hemorrhage (IVH) is a type of bleeding from fragile blood vessels in the brain. These blood vessels are especially fragile in premature infants. Babies who are born more than 8 weeks early (before 32 weeks of pregnancy, or 32 weeks of gestation) are most likely to have this bleeding.

A baby with IVH may:

• have no symptoms from the bleeding
• become sick from the bleeding, with symptoms of paleness, breathing problems, weak heart rate, and low blood pressure
• have seizures if the bleeding is severe
• develop hydrocephalus (increased fluid in the brain) because the blood plugs up the brain's fluid pathways (the ventricles).

Most intraventricular hemorrhages occur in the first week of life. They seldom occur after the first week.

Your physician will order an ultrasound scan of the baby's brain if the baby is more than 6 weeks premature (less than 34 weeks post-conceptional age) or if he or she thinks the baby might have IVH. The scan is done at the bedside and does not bother the baby. Ultrasounds are done every few days for the first week and then as needed.

CAUSE

Some very fragile blood vessels surround the ventricles of the brain. The ventricles are cavities in the brain through which cerebrospinal fluid (CSF) flows. The blood vessels are very underdeveloped in the very young infant. They start getting stronger after 32 weeks of gestation. These blood vessels are very sensitive to changes in blood flow. If the blood flow changes, the blood vessels break down and start bleeding. If the bleeding is slight, the blood remains around the blood vessels. If the bleeding gets worse, the blood breaks into the ventricles. In the worst cases of bleeding, the blood may leak into the brain tissue.

The hemorrhages are graded from 1 to 4 according to the severity of the bleeding. Small amounts of bleeding--grades 1 to 2--do not usually cause any long-term damage. Larger amounts of bleeding--grades 3 to 4--cause long-term problems. Grades 3 and 4 cause a blockage of the circulation system for cerebrospinal fluid. This blockage is called hydrocephalus.

The brain makes cerebrospinal fluid (also called spinal fluid), which circulates through the ventricular system in the brain and the central canal of the spinal cord. Hydrocephalus results from the blockage of the spinal fluid circulation pathways by blood clots. If the circulation of fluid is blocked, the fluid begins to build up and the ventricles begin to swell. If the ventricles swell to a large size, the fluid can press on the brain and cause damage. After IVH occurs, the hospital staff will watch closely for the development of hydrocephalus. If it occurs, there are treatments to keep the pressure under control.

TREATMENT

Unfortunately, there are no proven ways to stop IVH from happening. The best approach is to try to keep the brain from bleeding by keeping the baby as stable as possible. When IVH does occur, it is treated by looking for and treating the complications of the bleeding.

OUTCOME

There is no test or examination that can accurately predict what a baby will be like as a child or adult. Only time and growth will show whether the brain has been permanently hurt. Sometimes other parts of the baby's brain may be able to take over the function of any damaged areas. This means that babies often do much better than expected. They do much better than an adult with a similar brain injury. Love, care, and encouragement that the child receives from his family also have a very important effect on his outcome. Only time will tell to what extent a child's brain is injured and what long-term problems he will have.

Adapted from an article written by Patricia Bromberger, M.D., neonatologist, Kaiser Permamente, San Diego, CA  Copyright 1999 Clinical Reference Systems