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Intraventricular Hemorrhage of Infancy(IVH; Subependymal Germinal Matrix Hemorrhage; Early-onset Germinal Matrix Hemorrhage; EGMH; Periventricular-Intraventricular Hemorrhage; PIVH)

Pronounced: In-tra-ven-tric-ooh-lar Hem-or-age of In-fan-see

Definition

Intraventricular hemorrhage (IVH) is bleeding into the spaces of a baby’s brain. IVH is most common in premature babies.

IVH may cause damage to brain tissue and lead to long-term development problems.

Ventricles of the Brain

Ventricles of the Brain

Copyright © Nucleus Medical Media, Inc.

Causes

IVH is caused by the rupture of immature or fragile blood vessels in the brain. It is not clear why this happens but changes in blood pressure may play a role.

Risk Factors

Factors that increase your baby’s chance of developing IVH include:

  • Prematurity
  • Low birth weight
  • Lack of oxygen
  • Direct trauma to the baby’s head during birth
  • Breathing complications at birth
  • Infection that leads to blood clotting problems
  • Severe infection
Symptoms

It often occurs in the first 48 hours after birth. In many cases, there are no visible signs of IVH. Symptoms that may occur include:

  • Swelling of soft spots at the top of the head
  • Pauses in breathing
  • Seizures
  • Muscle spasms
  • Pale or blue color
  • Weak suck
Diagnosis

A physical exam will be done. The doctor will look for any signs of a brain injury.

An ultrasound will be used to make images of the brain structures, blood vessels, and blood flow in the brain.

Other tests, like blood tests, may be done to look for anemia and causes of the bleeding.

Treatment

In most cases, the bleeding gradually stops. Treatment options include:

  • Monitoring your baby’s condition to manage any complications.
  • Treating any other medical conditions associated with the bleeding.

Certain procedures or surgery may need to be done to relieve pressure in the brain:

  • Ventriculoperitoneal shunt—a tube that runs under the skin and allows fluid to drain from the ventricle (brain) to the abdomen
  • Lumbar puncture , fontanelle tap, or surgery—to drain fluid from your baby's brain
Prevention

If you are at risk of having a premature baby, you may be given medication to decrease the chance of IVH.

RESOURCES:

American Academy of Neurology
http://www.aan.com

Healthy Children—American Academy of Pediatrics
http://healthychildren.org

CANADIAN RESOURCES:

Canadian Pediatric Society
http://www.cps.ca

Health Canada
http://www.hc-sc.gc.ca

References:

Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res. 2010;67(1):1-8.

Cunningham FG, Leveno KJ, Bloom SL, et al. Diseases and injuries of the fetus and newborn. In: Obstetrics. 23rd ed. New York, NY: McGraw-Hill Books; 2010:605-645.

Intraventricular hemorrhage. Boston Children's Hospital website. Available at: http://www.childrenshospital.org/health-topics/conditions/intraventricular-hemorrhage. Accessed June 24, 2013.

Intraventricular hemorrhage of infancy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 24, 2011. Accessed August 12, 2014.

Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database of Syst Rev 2010;7:CD000174.



Last reviewed August 2014 by Kari Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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