What is an IVH

What causes an IVH

How is an IVH diagnosed

How is an IVH treated

Doctor visits

What do parents need to know

The future

Call the doctor if…

An IVH is bleeding in the baby’s head in the area around the ventricles of the brain.  

There are four (4) ventricles (cavities or hollow areas) in the brain that are filled with fluid (cerebral spinal fluid, also called CSF).  

Bleeding can happen in many different parts of the brain, but premature babies are more likely to have bleeding around the ventricles than in other areas.

  An IVH usually happens in the 1^st to 3^rd day of life, but may become larger in the 1^st week of life. 

 Pressure on the brain from the blood buildup can cause damage to the brain.

 IVH is very common in premature babies, the smaller the baby, the greater the chance of an IVH.

There are 4 degrees or grades of IVH.    (see next page)

	Grade I:  Bleeding near the ventricles (where spinal fluid is made).
	Grade 2:  Bleeding into the ventricles.
	Grade 3:  Bleeding into the ventricles; the ventricles enlarge and push against the brain.
	Grade 4:  Bleeding into the ventricles and into the brain tissue.

The higher the degree or grade of IVH the larger the amount of blood or bleeding in the baby’s head.

The blood that enters the baby’s ventricles may form a clot that sometimes blocks the drainage of fluid from the ventricles causing Hydrocephalus (see document by this name).

There are many tiny vessels in the baby’s brain.  These vessels have fragile walls that can weaken or rupture (break open) and cause the bleeding.

There are many reasons for an IVH but the most common reason seems to be being born prematurely.  Other reasons that may cause an IVH are:

	Increasing respiratory distress and decreased oxygenation
	Decreased blood pressure and flow, especially to the brain
	Infection
	Hypoglycemia (low blood sugar), over a long time
	Certain medications

The doctor will talk with you if he suspects an IVH.

Takes pictures of your baby’s brain using sound waves.

A sensor is placed over the baby’s soft spot on the head, sound waves measure the brain tissue and a picture is made.

This is like the ultrasound done on moms when they are pregnant.

This does not hurt your baby.  He can be awake or asleep for the test.

Uses a beam of x-ray to take pictures of the brain.

Your baby will go inside a large machine and he must be still for the test.  Often times your baby is given medicine to make him sleepy for the test.  A nurse watches him very closely during the test.

This test does not hurt your baby.

The primary treatment for an IVH is supportive by providing:

	Respiratory support and oxygen as needed
	Feedings and IV fluids for adequate growth
	Medications.

If the baby develops hydrocephalus, a shunt may be necessary.

A shunt is a device to drain the fluid.

The doctor will talk with you about the treatment needed.

Your baby needs to be followed by a neurosurgeon after discharge from the hospital.  A neurosurgeon is a doctor with special education and training in brain surgery.  He is the surgeon who will put your baby’s shunt in.

Your baby may also need to see a pediatric neurologist.  A pediatric neurologist is a doctor with special education and training in the development and working of a child’s brain.

 Your baby’s head will be measured with each doctor's visit.

The neurosurgeon will decide when any scans need to be repeated.

Handle your baby the same way you would any baby.

He can sleep in any position.

The higher the grade of bleeding or amounts of blood in the baby’s head, the greater the baby’s chance of having problems with his development.

	Grade I: The outcome for premature babies is very good, with only a small number of babies having any long-term neurological problems.
	Grade II: The outcome from premature babies is still good, but with a slightly higher number of babies having some long-term neurological problems.
	Grade III: About 40% of these babies will have some type of mild to moderate neurological problems.
	Grade IV: These babies have the greatest chance of having moderate to severe neurological problems.

At discharge, it may be impossible for us to know if your baby will have long-term problems or what the specific problem may be.  He may have no problems or he could have problems with hearing, vision, muscles, movement, or learning.  

The doctors will talk with you about the baby’s IVH grade and possible problems.

You think your baby is not acting as usual

You have any questions or concerns about caring for your baby.