What is intraventricular hemorrhage?
Intraventricular
hemorrhage occurs when there is bleeding in or around the ventricles of the
brain. This condition is more common in premature babies (although variants of
it occur in all age groups).
An intraventricular
hemorrhage can put pressure on the nerves in the brain and cause injury and
permanent damage.
When does intraventricular hemorrhage occur?
This condition is not
usually present at birth but occurs within the first three to four days after birth.
It is important to understand the signs and what to do if your child has it.
Babies born before 30
weeks or babies weighing less than 2.5 kg are advised to have an ultrasound
within a few days of birth. This is one of the most effective ways to find out
if the baby is suffering from intraventricular hemorrhage. After 1 month
outside the uterus, there is virtually no risk of intraventricular hemorrhage.
Degrees of intraventricular hemorrhages
From I to IV degree:
- Grade I - Bleeding from the ventricles in small areas (also known as germline hemorrhage)
- Grade II - intraventricular bleeding.
- Grade III - The blood causes the ventricles to enlarge and presses on the brain tissue.
- Grade IV - blood is found in the brain tissue surrounding the ventricles (also known as intraparenchymal hemorrhage).
Grades 1 and 2 are
the most common and refer to less bleeding. Typically, a grade 1 or 2
hemorrhage does not cause permanent damage and is treatable.
Grades 3 and 4 are
diagnosed when bleeding has entered the ventricles so much that they have
enlarged, and blood clots can block the flow of cerebrospinal fluid. This
increases the amount of fluid in the brain, also known as hydrocephalus.
Cause
There is no easily
determined cause of intraventricular hemorrhage. This condition occurs because
the blood vessels are not fully developed or are not strong enough to support
blood flow (which is why it is rare in more developed children).
While it can be
caused by head trauma or labor pressure, it can also happen without much
warning or reason.
Many factors can
contribute to the likelihood of this condition. Premature babies are most at
risk, especially those born ten weeks earlier or earlier. The more premature a
baby is, the higher the risk of this and other health complications.
Premature babies born
with breathing problems or other complications of prematurity are also at
higher risk. Babies who have other blood problems, infections, and/or shaken
baby syndrome have an increased risk of intraventricular hemorrhage.
Symptoms
Occasionally,
children with intraventricular hemorrhage may have few or no obvious symptoms.
In other cases, various symptoms may occur.
Because many of these
symptoms can also indicate other conditions, it's important to seek medical
attention if you notice any of the following symptoms:
- Apnea, or trouble breathing
- Decreased or slow reflexes
- Lethargy or baby is sleeping abnormally extended periods of time/often
- Changes in heart rate
- Weak suck during breastfeeding
- Seizures
- High-pitched crying
- Pale or blue coloring of the skin
- Decreased muscle tone
While none of these
symptoms are a sure sign of intraventricular hemorrhage, they can all indicate
a serious problem and should be brought to the attention of a healthcare
professional.
An ultrasound of the
head and blood tests can determine if the baby has intraventricular hemorrhage
and to what extent.
Ultrasound can also
help determine if the child has another disease or complication.
Common treatments
There is no natural
cure for intraventricular hemorrhage, but there are steps doctors and mothers
can take to prevent or reduce the effects of this condition.
Mothers at high risk
of preterm birth may be prescribed certain steroids to reduce the risk of them
developing in a premature baby.
If a child is found
to have an intraventricular hemorrhage, doctors may try to reduce symptoms and
stabilize the child to prevent further damage while it heals.
In the most extreme
cases, surgery may be used to try and stabilize the child. Before surgery,
doctors may drain cerebrospinal fluid with a needle or through less invasive
surgery to relieve pressure on the ventricles.
Typically, children
with less severe intraventricular hemorrhage heal spontaneously; however,
medical care can give them the best chance of recovery with little or no
damage.
Prognosis of intraventricular hemorrhage
The outcome depends
on the severity of intraventricular hemorrhage and the degree of prematurity of
the child during its development. The more developed a child is, the less he is
at risk.
Most children
suffering from grade 1 or 2 will survive with minimal damage.
Less than a third of
children in grades 3 or 4 die from it or may suffer serious long-term damage.
With proper treatment
and early detection, the prognosis can be very promising in most cases.
Tips for preventing intraventricular hemorrhage
It is difficult to
prevent intraventricular hemorrhages, except for some medications that can
reduce the risk and of course provide excellent care for premature babies.
Other factors that
may help reduce the risk of intraventricular hemorrhage include:
- Delivery in a hospital with a neonatal intensive care unit (so that babies can be treated faster and with minimal movement)
- Delayed cord clamping or cord blowing
- Take vitamin K before giving birth (especially for women who may be taking medications that interfere with blood flow and increase the risk of bleeding).
- If your baby was born prematurely or you are particularly concerned about this condition, talk to your doctor to find out what steps you can take to prevent and treat intraventricular hemorrhage.