Intraventricular Hemorrhage (IVH)

Intraventricular hemorrhage (IVH) is the most common type of intracranial bleeding in newborns, particularly affecting very preterm infants. It occurs when fragile blood vessels surrounding the brain’s ventricles—fluid-filled spaces where cerebrospinal fluid circulates—rupture and bleed into these spaces.

Due to improvements in prenatal and neonatal care, including antenatal corticosteroid administration and postnatal surfactant therapy, the incidence of IVH has steadily declined and is now observed in approximately 25% of very preterm infants.

Clinical presentation depends on the amount, location, and progression of the bleed:

• Small bleeds may be clinically silent
• Larger or rapidly progressing hemorrhages can cause anemia, apnea, seizures, lethargy, and decreased muscle tone or reflexes
• Ventricular dilation may manifest as a bulging fontanelle, widened cranial sutures, or a rapid increase in head circumference (>2 cm per week)

IVH can lead to hydrocephalus and is associated with an increased risk of long-term neurodevelopmental impairment.

IVH develops when immature and structurally fragile blood vessels rupture, often triggered by fluctuations in cerebral blood flow or pressure. Risk factors include extreme prematurity, infection, unstable blood pressure, and respiratory instability.