What is intraventricular hemorrhage?

Intraventricular hemorrhage (IVH) means bleeding into the normal fluid spaces (ventricles) within the brain. IVH is also used to refer to bleeding in areas near the ventricles even if the blood is not within them. The extent of IVH is graded:


Why do premature babies get IVH?

The brain is still developing. The area where IVH usually begins has a very fragile network of tiny blood vessels. These burst easily causing the bleeding. The more premature and the sicker the baby is, the greater the risk that s/he will develop IVH. The infants at highest risk are those weighing less than 1000 grams (2 1/4 lbs).


How will my doctors know if my baby has IVH?

Most of the time there are no outward signs that the bleeding has occurred; occasionally babies have seizures or sudden anemia. Babies at risk for IVH usually have an ultrasound of the head in the first 3-10 days of life. This painless test, performed in the isolette or bed, uses sound waves to give a picture of the baby's brain. If IVH is present, the baby may have this test repeated at regular intervals to see if the hemorrhage or the size of the ventricles are increasing.


How is IVH treated?

There is no specific treatment for IVH. Surgery will not prevent or cure the bleeding. Improved overall care and monitoring of premature babies has decreased the rate of IVH, but some babies still get it.


What are the complications of IVH?

Complications are most common with grades III and IV IVH. The most frequent complication of IVH is HYDROCEPHALUS or too much fluid collecting in the ventricles. This extra fluid may cause:


Why does a baby develop hydrocephalus?

The brain has four ventricles. Fluid, called cerebral spinal fluid (CSF), is normally made in the two larger ventricles. It passes between the ventricles by tiny channels and eventually goes outside the brain to bathe the outer brain and spinal cord. The fluid is absorbed into the body from outside the brain. Abnormal amounts of fluid collect in the ventricles when:


Can hydrocephalus be treated?

If your baby develops hydrocephalus, s/he needs some way for the fluid to escape from inside the brain. This may include:


Can IVH cause brain injury?

Grades I and II IVH are most common. They usually do not cause identifiable brain injury. The blood is slowly absorbed by the body. Babies with Grade III IVH are at increased risk of brain damage, but most are normal or near normal. Babies who have needed treatment for hydrocephalus and those with grade IV IVH are at very high risk for permanent brain injury.


How will I know if my baby will have long term problems?

This can only be determined over time by monitoring his/her development. For this reason it is important for premature infants, especially those with IVH, to have their development followed carefully after discharge.

Serious abnormalities that may appear are:

Less serious problems appear more slowly, are more difficult to detect, and may not be obvious until preschool or grade school. These can include:

If your baby has Grade III or IV IVH, s/he may be eligible for a developmental intervention program. Anytime in the future, if you are concerned about something that you think might be abnormal, have it checked out by your baby's regular doctor soon.

 

 
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