If your baby has been diagnosed with intraventricular hemorrhage, learning as much as you can about this condition can help you to understand what is going on with your baby and how they will recover.
Symptoms
Babies suffering from mild hemorrhages may not have any symptoms. Symptoms of more severe intraventricular hemorrhages in premature babies include:
Increased episodes of apnea and bradycardia Decreased muscle tone Decreased reflexes Weak suck Excessive sleep
In infants, intraventricular hemorrhages are categorized by how severe the hemorrhage is.
Grade 1: Bleeding is limited to the germinal matrix, a fragile area near the ventricles that contains many small capillaries. Bleeding can involve up to 10 percent of the ventricular area. Grade 1 IVH is also called germinal matrix hemorrhage. Grade 2: Bleeding is found in the ventricles and occupies between 10 to 50 percent of the lateral ventricle volume but the ventricles remain the same size. Grade 3: Bleeding is found in the ventricles, and the bleeding occupies more than 50 percent of the lateral ventricle volume and is associated with acute ventricular distension (expansion) related to the volume of blood. Grade 4: Blood is found in the ventricles, and there is infarction (tissue death) of the nearby white matter of the brain. Grade 4 IVH is also called periventricular hemorrhagic infarction (PVHI).
Causes
Bleeding occurs because the blood vessels in a premature baby’s brain are still very fragile and vulnerable to rupture.
Prematurity is the biggest risk for intraventricular hemorrhage, and most cases of IVH occur in babies less than 30 weeks gestation or under 1,500 grams (3 pounds, 5 ounces).
Doctors think that several things combine to make preemies susceptible to IVH. Beyond the fragility of blood vessels, premature babies also may suffer from repeated episodes of low blood-oxygen levels and exposure to greater fluctuations in blood pressure.
Diagnosis
Intraventricular hemorrhages are diagnosed with an ultrasound of the head. Many hospitals routinely screen all premature babies for IVH within the first week of life and again before hospital discharge.
Treatment
Unfortunately, there is no way to stop an intraventricular hemorrhage once it has begun. Treatment for IVH targets symptoms of the bleed and may include increased respiratory support or medications for apnea and bradycardia.
Hydrocephalus, also known as “water on the brain,” causes cranial swelling and places pressure on delicate brain tissue. Hydrocephalus may go away on its own, or surgery may be required. If needed, the doctor may insert a ventriculoperitoneal shunt (VP shunt) to drain the fluid and reduce pressure on the brain.
Prevention
Because IVH can cause severe complications and cannot be stopped once it has begun, doctors and scientists have focused their efforts on prevention. Preventing preterm delivery is the best way to prevent IVH, so expectant mothers with risks for preterm delivery should talk to their doctors about lowering their risk.
Several medications have been studied for their role in preventing IVH. Antenatal steroids in women who are at risk for an early delivery have been shown to give some protection, but must be given in a narrow time window.
