Intraventricular hemorrhage in premature infants

During the first week after birth, some premature infants develop bleeding in the brain (intraventricular hemorrhage), for which there is no known treatment. Bleeding severity is most often minimal (grades I and II), causing no noticeable brain damage. Grade III bleeding increases the risk of developing hydrocephalus (a buildup of excess cerebrospinal fluid within the brain), brain damage, or both. Grade IV is used to describe extensive bleeding that has led to brain damage that is visible on image studies.

The more immature the brain, the more fragile the brain's blood vessels and the more sensitive they are to changes in blood pressure. Extremely premature infants are therefore at greatest risk for intraventricular hemorrhage. While up to 80% of infants born at 23 to 24 weeks' gestation develop this condition, it is very rare among infants born at or beyond 35 weeks.¹

Regardless of an infant's gestational age at birth, the risk of intraventricular hemorrhage drops significantly after the first 72 hours of life and is negligible after 7 days of age. Very premature infants typically have an ultrasound of the head (cranial ultrasound) 3 to 7 days after birth to check for intraventricular hemorrhage. Those who show signs of bleeding are periodically checked thereafter.

Prevention measures that can reduce the risk of intraventricular hemorrhage include:¹

• Corticosteroid treatment, given to the mother before the birth. This treatment is typically given to help fetal lungs develop before a premature birth and is thought to make blood vessels less likely to bleed.
• Indomethacin, given to the infant after birth. This nonsteroidal anti-inflammatory drug (NSAID) tightens the brain's blood vessels (vasoconstriction), which helps control sudden changes in blood pressure in the brain.

Citations

1. Jones MD (2003). Intraventricular hemorrhage section of The newborn infant. In CD Rudolph et al., eds, Rudolph's Pediatrics, 21st ed., p. 144. New York: McGraw-Hill.