What is an intraventricular haemorrhage?

A haemorrhage means a bleed - that is blood leaking out of blood vessels into the area surrounding the blood vessel. An intraventricular haemorrhage (IVH) is a bleed into the brain. Specifically, a bleed into fluid-filled spaces in the brain, called ventricles.

An IVH can occur at any age. It is a type of ictus, and may be due to various causes including ipertensione, a head injury, abnormally formed blood vessels, or brain tumours.

This leaflet is specifically about intraventricular haemorrhage in newborn babies.

There is a high risk of IVH in babies who were born very early (premature babies).

In premature babies, the brain is still developing. The new blood vessels near the ventricles of the brain are very fragile. They can tear very easily, allowing blood to leak out and into the ventricles. Other medical conditions and fluctuations in the blood flow to the brain can make bleeding more likely.

IVH is common in very premature babies and rare in babies who were not born early (babies born at term). The earlier the baby is born, the higher the risk of IVH. Also the lower the birth weight, the more the risk of IVH. About one in four babies weighing less than 1500 g develop IVH.

Other problems can put a premature baby more at risk of developing IVH. Other medical problems affecting the steadiness of the blood flow to the brain can increase the risk. For example, breathing problems, infections, low oxygen levels, heart conditions, etc. All these conditions in themselves are more likely in premature babies, which all adds to the reasons for IVH occurring in this group of babies.

Babies born at term have IVH much less commonly. It is usually due to complicated difficult deliveries, or due to underlying medical problems (such as abnormal bleeding tendencies).

It depends on how big a bleed there has been. Small bleeds may not cause much harm and so there may not be any signs or symptoms. Larger bleeds will have more impact and may be more apparent. Bleeds are classified as Grades 1 to 4, depending on how much of the brain tissue is affected. Grade 1 is the mildest bleed, with Grade 4 being the most severe. These larger, more severe bleeds are more likely to cause long-term problems.

Possible signs of IVH include:

• Being more floppy.

• Being less alert.

• Convulsioni (attacchi epilettici).

• Swelling around the soft spots on the head (fontanelles).

• Breathing less regularly.

• Feeding less well.

• Change in colour (becoming more pale or developing a bluish colour).

IVH in most cases occurs within the first few days after the baby is born.

IVH is usually diagnosed with an ecografia. This is the type of scan you have when you are pregnant, but in this case the probe is placed over the soft spots (fontanelles) of the baby's head. The scan is painless and uses sound waves. It can be performed in the neonatal intensive care unit.

There is no specific treatment. Your baby will be monitored to check the area of bleeding is gradually getting smaller. Think of it like a bruise inside the brain - much like any other bruise the body gradually re-absorbs the blood and the swelling gradually settles down. Your baby will be monitored for any damage which might have been caused by this pressure on the brain.

Some babies develop an accumulation of fluid in the brain, causing an increased pressure in the brain - this is called hydrocephalus. Premature babies are monitored so that this is picked up early if it is happening. This is done by measuring the size of their heads and by regular ultrasound scans. Sometimes this needs treating by placing a shunt (drain) in the brain to help clear the extra fluid. This involves an operation.

For lower-grade haemorrhages, the outlook (prognosis) is good. Long-term damage is unlikely. However, for babies who have had Grade 3 or Grade 4 IVH, there is a risk that damage to the brain will have longer-term consequences. More than half of these babies have brain problems as a result of the IVH. The type of problems the baby may have in future include:

• Paralisi cerebrale.

• Difficoltà di apprendimento.

• Delays in development.

• Problems with eyesight or hearing.

Lots of research has been done and is being done to look at ways of preventing IVH. The most important factor is babies being born prematurely, but of course it is often not possible to prevent this. Giving steroid medicines per women in premature labour seems to help in preventing some cases of IVH.