Intraventricular Hemorrhage, Newborn

ExitCare ImageIntraventricular hemorrhage is bleeding in the brain. Intra means inside and ventricular refers to the place where the bleeding occurs. Hemorrhage means bleeding.

The bleeding occurs mostly in babies born early (prematurely). A premature baby is one born before the mother has been pregnant for 37 weeks. The bleeding usually occurs within the first few weeks after birth. A full-term baby also can develop intraventricular hemorrhage, but this is less common.

A baby with intraventricular hemorrhage will probably be treated in a special part of the hospital called a neonatal intensive care unit (NICU). The people who work in this area have been specially trained to care for newborns and very small babies.

CAUSES

If a blood vessel is not strong, it can break (rupture) more easily. For example, a sudden change in the pressure of blood flowing through the vessels can cause a break. That can lead to bleeding in the brain. There are many reasons for blood vessels to burst in the brain. Reasons might include:

  • Being born very early. Babies born before 30 weeks of pregnancy are affected most often. Their blood vessels have not had time to become as strong as they need to be.

  • Infection.

  • Heart Disease.

  • Respiratory Distress Syndrome.

  • Pneumothroax.

  • Difficult Birth.

SYMPTOMS

Premature babies often are checked for bleeding in their brain. That is because it can be hard to recognize signs or symptoms of the problem. Things that could indicate intraventricular hemorrhage include:

  • Seizures, coma or being hard to wake up.

  • Soft spots on the head (fontanel) that bulge out.

  • Difficulty breathing.

  • Rapid breathing.

  • The child has sudden stops, or breaks, in breathing (apnea).

  • Unusual heartbeat.

  • Pale skin.

  • The skin color seems blue, especially around the lips (cyanosis).

  • Trouble sucking.

  • A shrill cry.

DIAGNOSIS

First, the healthcare provider will decide if an infant has intraventricular hemorrhage. Ways to do this may include:

  • Asking about symptoms you have noticed.

  • Doing a physical examination of the baby.

  • Ordering an ultrasound of the head. This test can give a picture of the baby's brain. The machine uses sound waves to do this.

  • If bleeding is found, the healthcare provider will rate the condition. The rating describes how far the bleeding has spread in the brain.

  • Grade 1: The bleeding has stayed in the area where it began. Most babies will simply absorb the blood back into the body.

  • Grade 2: A small amount of bleeding has spread into the ventricles.

  • Grade 3: The bleeding has spread into the ventricles and may be making them larger than normal.

  • Grade 4: The bleeding is inside the brain tissue. There is a very high chance of brain injury.

TREATMENT

What can be done for the child depends on how much bleeding there is. Mild bleeding usually stops on its own. There is currently no way to stop more serious bleeding. Instead, medical experts will treat symptoms that develop. Be sure to discuss the different options with the child's healthcare provider. They may include:

  • Oxygen. Babies with this condition often have trouble breathing. Oxygen should help.

  • Tube feedings. Special equipment may be needed to make sure a premature baby gets needed food.

  • Blood transfusion. This gives more blood to babies who have lost a lot of it.

  • Relieving pressure. Fluid can build up in the brain (hydrocephalus). This puts pressure on the brain and may cause injury. Ways to prevent that include:

  • Spinal tap. This is also called a lumbar puncture. A needle is used to drain fluid from the spine which is connected to the fluid in the brain.

  • Shunt. This is a drain that is put in the brain. It helps keep fluid from building up. Surgery is needed to put in the shunt.

PROGNOSIS

Intraventricular hemorrhage is a very serious condition. The lasting effect varies from child to child. In part, this depends on how severe the bleeding was. Milder cases often have very few long-term effects. On the other hand, more severe bleeding in the brain can cause brain damage. Also, not all infants survive. Children with severe bleeding may develop slower than others and may have abnormal muscle tone or control.

HOME CARE INSTRUCTIONS

A baby with intraventricular hemorrhage may be in the hospital for quite awhile. The child will not be sent home until healthcare providers believe it is safe to do so. At home, the child's caregivers should:

  • Watch for apnea. A device, or monitor, can be used to alert you if the baby suddenly stops breathing.

  • Make sure that the child is seen by a healthcare provider regularly. This should continue for several years. During these visits, be sure to talk about developmental milestones that are coming up. Ask when the child should crawl, walk, talk.

SEEK MEDICAL CARE IF:

  • The baby seems to have trouble seeing or hearing.

  • The baby does not respond to your voice. This usually happens within three or four months after leaving the hospital.

  • The baby has seizures.

  • The baby does not speak or understand any words. This normally happens within a year of leaving the hospital.

  • The baby has problems with movements. This includes not crawling, not walking or moving very stiffly.