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IVH in a Premature Infant

IVH, or intraventricular hemorrhage, is bleeding into the fluid-filled areas surrounded by the brain, or the ventricles. Premature infants, particularly those born before the 30th week of pregnancy, are most at risk for IVH. The risk increases the smaller the infant and/or the more premature the infant. The reason for this is that blood vessels are not fully developed before 30 weeks, and are rather fragile prior to this point in gestation.

  1. Types

    • IVH is categorized as falling into grades 1 through 4; the higher the grade, the more severe the bleeding. Grades 1 and 2 don't involve as much bleeding and are typically not as serious. Grades 3 and 4 involve more bleeding and create pressure on the brain tissue. While Grades 1 and 2 don't typically cause long-term effects, Grades 3 and 4 can lead to hydrocephalus, or fluid in the brain, and other long-term effects.

    Time Frame

    • Intraventricular hemorrhages rarely show up at birth, but typically occur in the first several days of life, particularly in pre-term infants. No matter how premature the baby, IVH is rare after one month of age. More than half of all cases of IVH happen in the first 24 hours after birth, with less than 5 percent occurring after day 5.

    Symptoms

    • The symptoms of intraventricular hemorrhage include apnea, or pauses in breathing, decreased muscle tone and reflexes, excessive sleeping, lethargy, and inadequate or weak sucking. Serious effects later seen include mental retardation, cerebral palsy, seizures and death.

    Risk Factors

    • Risk factors for IVH include low birth weight, preterm labor, maternal smoking, breech birth, prolonged labor, premature rupture of membranes, resuscitation and intubation after birth, respiratory distress syndrome, pneumothorax, infections and fertility treatment, particularly in-vitro fertilization.

    Prevention/Solution

    • There is no treatment available for IVH, except to care for the infant to make the child as stable as possible and to treat related problems if indicated, or to treat fluid on the brain with a spinal tap or by surgically placing a tube or shunt to drain the fluid. IVH may be prevented by administering corticosteroids to pregnant women at risk for delivering a premature infant and treating infections in the mother with antibiotics prior to birth.

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