Intraventricular Hemorrhage (IVH) and Cerebral Palsy

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Intraventricular hemorrhage (IVH) is bleeding in the brain that may occur either before or shortly after birth. IVH can damage parts of the brain responsible for motor development, which can lead to cerebral palsy.[1]

What Causes IVH?

Several factors can contribute to a heightened risk of an infant developing IVH, including:

• Placental problems, such as placenta previa or blood clots in the placenta
• Infant stroke
• Neonatal transport
• Trauma during labor, such as head injuries
• Mechanical ventilation, episodes of respiratory distress, or oxygen deprivation[2]
• Macrosomia (large baby)
• Medical negligence when using birth-assisting tools, such as forceps
• Maternal infection or hypertension
• Unstable infant blood pressure
• Prematurity or very low birth weight
• Head injury
• Vitamin K deficiency

The greatest independent risk factor for IVH is prematurity, and thus the incidence is much less in full-term infants. Cases of IVH in term babies are usually related to lack of oxygen or birth trauma.

Symptoms of IVH

In some cases, the presentation may be “silent,” meaning infants may not exhibit any symptoms at all, but other times, symptoms may include:

• Abnormal blood pressure and heart rate
• Pauses in breathing
• Decreased reflexes and muscle tone
• Fatigue and excessive sleep
• Abnormal body movements
• Seizures
• Coma

How Severe Is IVH?

Cases of intraventricular hemorrhage are graded based on the severity of the bleeding within the brain and the amount of brain tissue that is affected.

Grade I

Grade I is the mildest form of IVH, and in most cases, the bleeding is minimal with no long-term problems. In grade I injury, the bleeding is mostly contained in the germinal matrix, which is the area just around the ventricles.

Grade II

Grade II is still considered a relatively mild form of IVH but slightly more serious than grade I. It involves between 10 and 50% of the ventricles. However, similar to grade I bleed, there is a low risk of long-term problems.

Grades III and IV

The most severe forms of IVH, grades III and IV, are marked by substantially more bleeding in the brain, with grade IV being the most severe.

These forms of IVH usually result in more symptoms, and the infant will have a greater risk of long-lasting effects from injury to the brain tissue.

In these higher grades of IVH, the bleeding and swelling can cause a condition known as hydrocephalus, marked by an increased amount of fluid in the brain and enlargement of the ventricles.

In addition, Grades III and IV IVH can lead to blood pressure changes, resulting in a possible rupture of blood vessels if not treated in time.

How Do Doctors Diagnose IVH?

Generally, diagnosis occurs after a physician detects that blood has reached the ventricles. This can be done with an ultrasound, which is the most common method for determining the presence of a bleed. An ultrasound is often part of routine care in very premature infants because the risk for them is so high.

With ultrasound views, the grade of bleed can usually be identified. An MRI is an even more sensitive study to diagnose IVH, especially the milder forms that may not show up as well on ultrasound.

How Is IVH Treated?

Although it is not possible to prevent all forms of IVH, physicians will try to keep the baby as calm and stable as possible with very close and continuous monitoring.

In more severe cases, an infant may need treatment:[3]

• Blood transfusion
• Spinal tap to reduce swelling
• Ventilator to assist with breathing

What Is the Prognosis for a Baby with IVH?

In most instances, babies with grade I IVH will not experience developmental delays or develop cerebral palsy, although the risk is always there.[4] However, most infants in this category of bleeding will heal and improve without any long-term damage.

As the grade of bleed increases, the risks of effects on growth and development increase. The baby will then need specialized care and therapy. They may also need surgery to correct the fluid imbalances in the ventricles.

Can IVH Be Prevented?

It’s ideal to deliver an infant as close to their due date as possible, as babies born prematurely run the highest risk of developing IVH.

Although it’s not always possible to carry a pregnancy to term, there are several things you can do to lessen the risk of delivering your baby prematurely:

• Keep all medical appointments and get routine prenatal care.
• Do not drink alcohol, smoke, or use illicit drugs while pregnant.
• Maintain a healthy, nutritious diet.
• If you are at a high risk of delivering early, consult with your physician about how and where the delivery should take place and any precautions or special care you might need.
• Ask your doctor about taking vitamin K if you take medications that may promote bleeding.

If your baby is born with IVH, talk to your doctor about treatments immediately. Consider contacting a lawyer if you believe a doctor’s negligence caused this damage.