What is intraventricular hemorrhage (IVH)?
The ventricles are spaces inside the brain. Ventricles contain
a liquid, called cerebrospinal fluid, that is important for brain
function. With IVH, small blood vessels near the ventricles
break and leak blood into the ventricles.
What are the risk factors for IVH?
The highest risk for IVH is in babies born more
than 10 weeks early. Premature babies are
also at higher risk for IVH if they have other
health problems, such as respiratory distress
syndrome, infection, or unstable blood pressure,
or if the mother had an infection before the baby
What are the symptoms of IVH?
Many babies with IVH do not have any symptoms.
When symptoms occur, they may include:
• Short stops in breathing (apnea)
• Low blood pressure
• Slow heart rate
• Decreased muscle tone and reflexes
How is IVH diagnosed?
Almost all cases of IVH occur within one week of birth. Very
premature babies (born at less than 30 to 32 weeks gestation)
are routinely screened for IVH before they are 14 days old. Premature
babies are usually screened if they have risk factors, such as breathing problems or an infection.
Babies are screened for IVH using an ultrasound machine. This machine generates a picture of
the baby’s brain. The test is painless and is usually done at the bedside in the NICU.
What are the different grades of IVH?
There are four grades of IVH. With grades 1 and 2 IVH, there is a small amount of bleeding in the
ventricles. With grade 3 IVH, there is enough bleeding that the ventricles become enlarged. With
grade 4 IVH, blood leaks from the ventricles into the brain tissue.
Treating Intraventricular Hemorrhage
Does IVH cause permanent problems?
The long-term impact of IVH depends on both the amount of
bleeding and the location of the bleeding within the brain. In most
cases, babies with grade 1 or 2 IVH do not have any long-term
problems as a result of the bleeding.
Babies with grade 3 or 4 IVH may develop blood clots that block
the movement of the fluid through the ventricles. This is called
hydrocephalus. With this extra fluid, the ventricles may swell and
push on the brain, possibly causing damage.
IVH increases the risk of another kind of brain injury called
periventricular leukomalacia (PVL). This happens when small
areas of the brain near the ventricles are damage Babies
with PVL are at risk for developmental problems.
What treatment will my baby receive?
Your baby will receive treatment to keep him or her stable and
to relieve any symptoms that are caused by IVH. Treatment may
include supportive care, blood transfusions, and medicines.
Babies with grade 3 or 4 IVH who develop hydrocephalus may
need treatment to relieve the pressure in the ventricles. If this is
necessary, the health care team will describe the procedure to you
How is IVH monitored?
IVH is usually monitored using ultrasound scans. If doctors
need more information, they may order a more detailed test
such as a CT scan or MRI.
What will happen next?
Each baby is different, but the long-term effects of IVH are related
to the location and the amount of bleeding that occurred. Be sure
to keep all follow-up appointments after you leave the hospital.
Children who had IVH as infants may need to be checked for
several years to see if the bleeding harmed the brain. Talk to
your baby’s health care team. They can answer any questions
you have about your baby.
Apnea – a brief stop in breathing
Cerebrospinal fluid (CSF) – fluid
that surrounds the brain and spinal
CT scan – painless test that
uses X-rays to create a 3D
picture of structures inside
Hydrocephalus – extra fluid inside
MRI – painless test that produces
an image of structures inside the
body. MRI machines do not use
(PVL) – type of brain damage
involving small areas of tissue
near the ventricles
Respiratory distress syndrome –
a condition that makes it hard for
babies to breathe
Ultrasound – painless test that
uses sound waves to create
a picture of structures inside
Ventricles – fluid-filled spaces
in the brain