Intraventricular Hemorrhage of Infancy

(IVH; Subependymal Germinal Matrix Hemorrhage; Early-onset Germinal Matrix Hemorrhage; EGMH; Periventricular-Intraventricular Hemorrhage; PIVH)
  • 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
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  • 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/

    American Academy of Pediatrics http://www.aap.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. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site1185/mainpageS1185P0.html . Accessed June 24, 2013.

    Intraventricular hemorrhage in infancy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated March 24, 2011. Accessed June 24, 2013.

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

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