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Treatment of Intraventricular Hemorrhage (IVH)

Intraventricular hemorrhage (IVH) is bleeding into the ventricles of the brain. IVH is generally caused by blood pressure changes that cause the immature blood vessels of the baby’s brain to rupture. It may occur because of direct trauma to the baby’s head, even as a result of normal vaginal delivery if excessive pressure is exerted on the head by the bony pelvis or by forceps or vacuum). In most cases, the IVH does not produce any symptoms or signs since they are usually small bleeds. They are only visible on ultrasound scans of the baby’s head. The bleeding gradually stops and the blood vessels heal themselves. There are no immediate treatments necessary. If damage has occurred to brain tissue, this does not heal and there may be long-term problems with development.

In more severe cases of IVH, other treatments may be necessary. Blood pressure must be monitored and maintained in the normal range. At times, the bleeding and pressure within the ventricles of the brain can interfere with the flow of cerebrospinal fluid (CSF). Over time, typically a few weeks, it may cause a condition called hydrocephalus, where there is a build-up of CSF in the ventricles of the brain due to blocked flow from blood clots. This causes enlargement of the baby’s head.

The treatment of hydrocephalus may involve the surgical placement of a shunt, which is a thin tube that drains off the CSF from the brain to another part of the body such as the abdomen. Prior to surgery, CSF may be drained off using a needle to relieve pressure in the ventricles and relieve symptoms of increased pressure on the brain. More detailed information on hydrocephalus can be accessed using the links in the menu box on the left of this page.

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Hilary Whyte, MSc, MB, BCh, BAO, MRCPI, FRCPC