Intraventricular hemorrhage
Intraventricular hemorrhage (IVH) is a serious condition characterized by bleeding into the brain's ventricles, most commonly affecting premature infants, particularly those weighing less than 1,500 grams (approximately 3 pounds, 5 ounces). The condition often arises due to oxygen deprivation during or after delivery, leading to the rupture of fragile blood vessels in the developing brain. Symptoms may be minimal, with some infants showing signs like seizures or anemia. Diagnosis typically involves cranial ultrasound performed on high-risk infants within the first ten days of life. IVH is classified into four grades based on severity, with Grade I being the least severe and Grade IV potentially causing significant brain injury and complications such as hydrocephalus. Treatment options mainly focus on managing symptoms, as there is no specific cure for IVH. Interventions like intravenous indomethacin and maternal corticosteroids have been shown to reduce the incidence of severe IVH. While advances in neonatal care have improved outcomes, the condition still poses a risk for long-term developmental challenges, particularly in more severe cases.
Intraventricular hemorrhage
Anatomy or system affected:Brain, nervous system
Definition:Bleeding into or around the normal fluid spaces within the brain.
Causes and Symptoms
Intraventricular hemorrhage (IVH) occurs most commonly in premature babies, especially those weighing under 1,500 grams (3 pounds, 5 ounces). IVHs have been seen as well in adults as a secondary complication of hemorrhagic stroke, leaving the individual with a poor prognosis.
IVH in premature babies is thought to occur when there is oxygen deprivation during delivery or complications following delivery. Since the blood vessels in the brain of the baby are fragile, they may rupture easily, resulting in excessive bleeding into (intraventricular) or around (periventricular) the ventricles. Generally, there are no outward symptoms. Some infants with IVH may suddenly develop seizures or anemia. IVH is usually diagnosed by cranial ultrasound routinely done on high-risk infants between three and ten days of life, since most cases occur by day three.
Intraventricular hemorrhages are categorized into four grades based on severity. Grade I involves bleeding confined to the small area where it began. Grade II involves blood extending into the ventricles, with no ventricular enlargement. Grade III involves more blood extending into the ventricles, with ventricular enlargement. Grade IV has blood collecting within the brain tissue (intraparenchymal hemorrhage), reflecting injury to the brain. Hydrocephalus (or too much fluid in the brain wherein the spaces, or ventricles, become enlarged) is a common complication of Grade III or IV bleeds.
Treatment and Therapy
Premature babies are given intravenous indomethacin once daily for the first three days of life to decrease the likelihood of severe IVH. Steroids (corticosteroids) given to the mother prior to delivery have also decreased the frequency of severe IVH, as have improved monitoring and care of premature babies. No specific treatment exists for IVH except to treat symptoms and underlying health problems. If hydrocephalus develops, it can be treated with frequent lumbar punctures or ventricular taps. If the condition persists, a shunt may be placed surgically to drain the extra CSF throughout life. In adults who suffer IVH secondary to hemorrhagic stroke, fibrolytic agents (so-called clot busters) are being evaluated as a mode of treatment.
Perspective and Prospects
IVH has been reported in 35 to 50 percent of infants weighing under 1,500 grams (3 pounds, 5 ounces). If IVH is suspected, a doctor may order an ultrasound to diagnose the condition and evaluate the amount of bleeding. As gestational age increases, the likelihood of IVH decreases. The care of sick and premature babies has advanced greatly, but there is still no way to definitively prevent IVH from occurring. Grade I IVHs rarely involve long-term problems. Those classified as Grade IV generally do result in long-term sequelae, including motor problems, developmental delay, seizures, blindness, and deafness.
Bibliography
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"Intraventricular Hemorrhage (IVH)." Boston Children's Hospital, www.childrenshospital.org/conditions/intraventricular-hemorrhage. Accessed 25 July 2023.
Klaus, Marshall H., and Avroy A. Fanaroff, eds. Klaus and Fanaroff's Care of the High-Risk Neonate. 7th ed. Elsevier, 2020.
Maas, Matthew B., et al. "Delayed Intraventricular Hemorrhage is Common and Worsens Outcomes in Intracerebral Hemorrhage." Neurology, vol. 80, no. 14, 2013, pp. 1295–1299.
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