What is Intraventricular Hemorrhage (IVH)?

Intraventricular hemorrhage (IVH) means bleeding inside the brain. The bleeding happens in areas called ventricles, which are spaces in the brain filled with fluid. This usually occurs within the first few days after birth, especially in premature babies (born before 37 weeks).

How IVH affects a baby depends on the amount of bleeding:

• Mild bleeding often gets better on its own and may not cause long-term problems.

• Severe bleeding can injure the brain and may lead to:

  • Trouble with movement or muscle control (cerebral palsy).

  • Seizures.

  • Developmental delays.

What Causes IVH?

IVH happens when tiny blood vessels in a baby’s brain break or leak.
This can occur because of:

• Fragile blood vessels in premature babies.

• Sudden changes in blood pressure or blood flow to the brain.

• Blood-clotting problems.

• Inherited (genetic) conditions that make bleeding more likely.
  
  

Who Is at Higher Risk?

IVH is more likely in babies who:

• Are born before 32 weeks of pregnancy.

• Have low birth weight.

• Needed help with breathing (oxygen or ventilator).

• Had low or unstable blood pressure or infection.

• Had a difficult or long delivery.

What Are the Symptoms?

Many babies with IVH show no visible signs. If symptoms appear, they may include:

• Pale skin or anemia (low red blood cell count).

• Breathing problems or sudden pauses in breathing.

• Sudden changes in heart rate or oxygen levels.

• Low blood pressure.

• Seizures or uncontrollable shaking.

• A bulging or widening soft spot (fontanel) on the head.

If bleeding blocks fluid flow in the brain, the head may start to grow too quickly — a sign of hydrocephalus (fluid buildup in the brain).

How Is IVH Diagnosed?

Doctors use:

• A physical exam.

• Ultrasound or MRI of the baby’s head.

IVH is classified into four grades:

Grade     Description

 1         Bleeding is small and stays where it started.

 2                                                            Bleeding spreads slightly into the ventricles.

 3 More bleeding enlarges the ventricles.

 4 Bleeding extends into surrounding brain tissue (most severe).

How Is IVH Treated?

Treatment depends on how much bleeding there is:

• Mild cases – may heal on their own with monitoring.

• Severe cases – may need:

  • Oxygen or ventilator support.

  • Blood transfusions.

  • Medicines to control seizures.

If there’s fluid buildup (hydrocephalus), your baby may need:

• Surgery to insert a small tube (shunt or reservoir) to drain excess fluid.

• Procedures to remove extra fluid and reduce pressure.

• Repeated ultrasounds or MRIs to monitor brain changes.

Care in the NICU

In the newborn intensive care unit (NICU), the team will:

• Monitor your baby’s vital signs closely.

• Keep the environment quiet and dim to help the baby rest.

• Give vitamin K to prevent bleeding.

• Provide medicines that reduce the risk of further bleeding.

• Encourage gentle touch and bonding when it’s safe.
  
  

Home Care After Discharge

• Watch your baby’s breathing and activity closely.

• Give medicines only as prescribed.

• Attend all follow-up visits to monitor head growth and development.
  
  

When to Call Your Doctor

Contact your doctor if your baby:

• Has trouble seeing or hearing.

• Has stiff or abnormal movements.

• Isn’t responding to your voice by 3 months.

• Isn’t using or understanding words by 1 year.

Get Emergency Help Immediately If:

• Your baby has trouble breathing or sudden pauses in breathing.

• Your baby shakes uncontrollably or has a seizure.
  
  

Summary

• IVH is bleeding inside the brain, most often in premature or very small babies.

• Mild cases may heal on their own, but severe bleeding can cause long-term brain injury.

• Regular checkups, developmental follow-up, and early therapy can help your baby reach their full potential.