Just as preemies’ lungs, eyes, and other body systems are fragile, so is their brains. One common complication seen in very premature infants is minor bleeding in the brain. Fortunately, this bleeding does not occur in actual brain tissue, but rather it occurs in the ventricles. These are the spaces filled with spinal fluid located in the middle of the brain. This bleeding is called intraventricular hemorrhage (IVH). Since the ventricles are not involved in any neurologic functions, a small amount of blood in the space is not a problem. However, a larger bleed can lead to increased pressure build up and the potential for blood to leak into the brain tissue.
Why does IVH occur?
At the bottom of the ventricles is a delicate structure called the germinal matrix. This contains very fragile blood vessels. The trauma of premature birth and neonatal life can cause these tiny capillaries to bleed into the germinal matrix.
How is IVH classified?
Depending on its severity, the bleed can be classified as a Grade I to a Grade IV.
Grades I & II
Usually do not cause any problems and will resolve on their own without treatment.
Grade III
Ventricles start to enlarge, putting pressure on the surrounding brain. This can lead to other problems such as hydrocephalus or minor brain injury.
Grade IV
Less common and the most severe type. It occurs when blood leaks out of an enlarged ventricle and into the surrounding brain tissue. This can cause major brain injury.
How is IVH treated?
The main treatment for IVH is the prevention, as there is no special course of treatment to make a bleed stop. Even a large IVH will eventually stop bleeding, as the extra fluid is reabsorbed and the swelling of the ventricles is resolved. In the first week of life, most preemies will be screened for IVH via an ultrasound of the brain. Over the years, improvements in neonatal care have lowered the incidence of IVH. Many NICUs have implemented neuroprotection bundles for the purpose of optimizing the quality of life and ensuring the best possible future for preemies and their families.