INTRAVENTRICULAR HEMORRHAGE
(IVH)
CONTENT
What is an IVH
What causes an IVH
How is an IVH diagnosed
How is an IVH treated
Doctor visits
What do parents need to know
The future
Call the doctor if…
WHAT IS AN IVH
1. An IVH is bleeding in the baby’s head in the area around the ventricles of the brain.
2. There are four (4) ventricles (cavities or hollow areas) in the brain that are filled
with fluid (cerebral spinal fluid, also called CSF).
Normal Ventricles
No Bleeding
3. Bleeding can happen in many different parts of the brain, but premature babies are
more likely to have bleeding around the ventricles than in other areas.
4. An IVH usually happens in the 1st to 3rd day of life, but may become larger in the 1st
week of life.
5. Pressure on the brain from the blood buildup can cause damage to the brain.
6. IVH is very common in premature babies. The smaller the baby, the greater the
chance of an IVH.
7. There are 4 degrees or grades of IVH. (see pictures next page)
Grade I: Bleeding near the ventricles (where spinal fluid is made).
Grade 2: Bleeding into the ventricles.
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Grade 3: Bleeding into the ventricles; the ventricles enlarge and push against the
brain.
Grade 4: Bleeding into the ventricles and into the brain tissue.
Grade I
Grade II
Grade III
Grade IV
8. The higher the degree or grade of IVH the larger the amount of blood or bleeding in
the baby’s head.
9. The blood that enters the baby’s ventricles may form a clot that sometimes blocks
the drainage of fluid from the ventricles causing Hydrocephalus (see document by
this name).
WHAT CAUSES AN IVH
1. There are many tiny vessels in the baby’s brain. These vessels have fragile walls that
can weaken or rupture (break open) and cause the bleeding.
2. There are many reasons for an IVH but the most common reason seems to be being
born prematurely. Other reasons that may cause an IVH are:
a. Increasing respiratory distress and decreased oxygenation
b. Decreased blood pressure and flow, especially to the brain
c. Infection
d. Hypoglycemia (low blood sugar), over a long time
e. Certain medications.
3. The doctor will talk with you if he suspects an IVH.
HOW IS IT DIAGNOSED
There are several tests that can be done to diagnose an IVH and find out how it is
doing. These tests are:
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1. Head Ultrasound
a. Takes pictures of your baby’s brain using sound waves.
b. A sensor is placed over the baby’s soft spot on the head, sound waves measure
the brain tissue and a picture is made.
c. This is like the ultrasound done on moms when they are pregnant.
d. This does not hurt your baby. He can be awake or asleep for the test.
2. CT or CAT SCAN: Stands for Computerized Axial Tomography.
a. Uses a beam of x-ray to take pictures of
the brain.
b. Your baby will go inside a large machine and
he must be still for the test. Often times
your baby is given medicine to make him
sleepy for the test. A nurse watches him
very closely during the test.
c. This test does not hurt your baby.
HOW IS AN IVH TREATED
1. The primary treatment for an IVH is supportive by providing:
a. Respiratory support and oxygen as needed
b. Feedings and IV fluids for adequate growth
c. Medications.
Baby going into
CAT Scan
2. If the baby develops hydrocephalus, a shunt may be necessary.
a. A shunt is a device to drain the fluid.
3. The doctor will talk with you about the treatment needed.
DOCTOR VISITS
1. Your baby may need to be followed by a neurosurgeon after discharge from the
hospital. A neurosurgeon is a doctor with special education and training in brain
surgery. He is the surgeon who will put your baby’s shunt in.
a. The neurosurgeon will decide when any scans need to be repeated.
2. Your baby may also need to see a pediatric neurologist. A pediatric neurologist is a
doctor with special education and training in the development and working of a child’s
brain.
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3. Your baby’s head will be measured with each doctor’s visit.
WHAT DO PARENTS NEED TO KNOW
1. Handle your baby the same way you would any baby.
2. He can sleep in any position.
THE FUTURE
1. The higher the grade of bleeding or amounts of blood in the baby’s head, the greater
the baby’s chance of having problems with his development.
a. Grade I: The outcome for premature babies is very good, with only a small
number of babies having any long-term neurological problems.
b. Grade II: The outcome for premature babies is still good, but with a slightly
higher number of babies having some long-term neurological problems.
c. Grade III: About 40% of these babies will have some type of mild to moderate
neurological problems.
d. Grade IV: These babies have the greatest chance of having moderate to severe
neurological problems.
2. At discharge, it may be impossible for us to know if your baby will have long-term
problems or what the specific problem may be. He may have no problems or he could
have problems with hearing, vision, muscles, movement, or learning.
3. The doctors will talk with you about the baby’s IVH grade and possible problems.
CALL THE DOCTOR IF…
1. You think your baby is not acting as usual
2. You have any questions or concerns about caring for your baby.
Reviewed/Revised: 3/03…..06/13
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