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Intraventricular Haemorrhage (IVH)

Intraventricular Haemorrhage (IVH) - What it is

​Intraventricular haemorrhage (IVH) is bleeding around or inside the spaces (ventricles) in the brain containing cerebral spinal fluid.  It is most common in premature babies, more specifically those who are less than 1500g or less than 35 weeks gestation.

Intraventricular Haemorrhage (IVH) - Symptoms

The more common symptoms associated with IVH are:
  • Apnoea or temporary cessation of spontaneous breathing
  • Bradycardia or slowing down of heart rate
  • Poor suck
  • Seizures
  • Cyanosis (bluish discoloration of the skin) 
  • Pallor
  • Hydrocephalus or the accumulation of fluid and/or blood in the brain ( in severe cases) 

Intraventricular Haemorrhage (IVH) - How to prevent?

Preterm infants have very fragile blood vessels in their brains.  Despite having the best of care, sometimes IVH still happens.  Some interventions to reduce the occurrence of IVH are:
  • Prevention of premature delivery by advocating early and regular prenatal care 
  • Prenatal steroids during pregnancy
  • Monitor blood pressure closely and avoiding sudden/frequent fluctuations
  • Minimal handling of extremely premature and extremely small babies once they are born
  • Avoiding excessive changes in breathing parameters and support
  • Timely treatment of Patent Ductus Arteriosus 

Intraventricular Haemorrhage (IVH) - Causes and Risk Factors

​Prematurity is a major cause of IVH.  Babies delivered less than 32 weeks gestation are at significant risk of developing IVH.  Other causes and risk factors include very low birth weight (VLBW) of less than 1500g, premature rupture of membranes, intrauterine infection, early onset infection in the baby, postnatal resuscitation and intubation, high-frequency mode of ventilation, frequent fluctuations in blood pressure and Patent Ductus Arteriosus. 

Intraventricular Haemorrhage (IVH) - Diagnosis

A Cranial (head) ultrasound coupled with good medical history and a physical examination is usually used to diagnose IVH. Through spaces between the bones of the baby’s head (fontanelle), the amount of bleeding can as graded as follows:

Grade 1. Bleeding occurs just in a small area of the ventricles.

Grade 2. Bleeding also occurs inside the ventricles.

Grade 3. Ventricles are enlarged by the blood.

Grade 4. Bleeding into the brain tissues around the ventricles.

Intraventricular Haemorrhage (IVH) - Treatments

There is no specific treatment for IVH.  Therapy is aimed at correcting the other medical conditions associated with IVH (i.e. correction of bleeding, treatment of infections, etc.).  In general, IVH grades 1 and 2 are still most common and usually self-limiting.  They are not associated with any long-term complications and more often does not require further intervention.  Grades 3 and 4 are more serious and may have long-term sequelae if left untreated.  There are some cases when moderate-severe IVH may require placement of a reservoir or shunt if spinal fluid distends the ventricles and leads to expansion of the head size (hydrocephalus). This is secondary to blockage of spinal fluid within the brain and expansion of the head as a result.

Babies with IVH are high risk for developing long term neurological problems and delayed development. 

Intraventricular Haemorrhage (IVH) - Preparing for surgery

Intraventricular Haemorrhage (IVH) - Post-surgery care

Intraventricular Haemorrhage (IVH) - Other Information

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth