• Intraventricular Hemorrhage of Infancy

    (IVH; Subependymal Germinal Matrix Hemorrhage; Early-onset Germinal Matrix Hemorrhage; EGMH; Periventricular-Intraventricular Hemorrhage; PIVH)


    Intraventricular hemorrhage (IVH) is bleeding into the spaces of a baby’s brain. IVH is most common in premature babies.
    IVH may cause damage to brain tissue and lead to long-term development problems.
    Ventricles of the Brain
    Ventricles of the Brain
    Copyright © Nucleus Medical Media, Inc.


    IVH is caused by the rupture of immature or fragile blood vessels in the brain. It is not clear why this happens, but changes in blood pressure may play a role.

    Risk Factors

    Factors that increase your baby’s chance of developing IVH include:
    • Prematurity
    • Low birth weight
    • Lack of oxygen
    • Direct trauma to the baby’s head during birth
    • Breathing complications at birth
    • Infection that leads to blood clotting problems
    • Severe infection


    It often occurs in the first 48 hours after birth. In many cases, there are no visible signs of IVH. Symptoms that may occur include:
    • Swelling of soft spots at the top of the head
    • Pauses in breathing
    • Seizures
    • Muscle spasms
    • Pale or blue color
    • Weak suck


    A physical exam will be done. The doctor will look for any signs of a brain injury.
    An ultrasound will be used to make images of the brain structures, blood vessels, and blood flow in the brain.
    Other tests, like blood tests, may be done to look for anemia and causes of the bleeding.
    There are 4 grades of intraventricular hemorrhage that are based on severity:
    • Grade 1: Bleeding is contained to a small area of the ventricles
    • Grade 2: Bleeding also occurs inside the ventricles
    • Grade 3: Ventricles become enlarged by blood
    • Grade 4: Bleeding into brain tissues and around ventricles


    In most cases, the bleeding gradually stops. Treatment options include:
    • Monitoring the baby’s condition to manage any complications.
    • Treating any other medical conditions associated with the bleeding.
    Certain procedures or surgery may need to be done to relieve pressure in the brain:
    • Ventriculoperitoneal shunt—a tube that runs under the skin and allows fluid to drain from the ventricle (brain) to the abdomen
    • Lumbar puncture , fontanelle tap, or surgery—to drain fluid from the baby's brain


    If you are at risk of having a premature baby, you may be given medication to decrease the chance of IVH.


    American Academy of Neurology http://www.aan.com

    Healthy Children—American Academy of Pediatrics http://healthychildren.org


    Caring for Kids—Canadian Pediatric Society http://www.caringforkids.cps.ca

    Health Canada https://www.canada.ca


    Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res. 2010;67(1):1-8.

    Intraventricular hemorrhage. Stanford Children's Health website. Available at: http://www.stanfordchildrens.org/en/topic/default?id=intraventricular-hemorrhage-90-P02608. Accessed September 25, 2017.

    Intraventricular hemorrhage. Boston Children's Hospital website. Available at: http://www.childrenshospital.org/health-topics/conditions/intraventricular-hemorrhage. Accessed September 25, 2017.

    Intraventricular hemorrhage. About Kids Health—The Hospital for Sick Children website. Available at: http://www.aboutkidshealth.ca/En/ResourceCentres/PrematureBabies/AboutPrematureBabies/BrainandBehaviour/Pages/Intraventricular-Hemorrhage-IVH.aspx. Accessed September 25, 2017.

    Intraventricular hemorrhage of infancy. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116485/Intraventricular-hemorrhage-of-infancy. Updated August 22, 2016. Accessed September 25, 2017.

    Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database of Syst Rev 2010;7:CD000174.

    Revision Information

    • Reviewer: EBSCO Medical Review Board Kari Kassir, MD
    • Review Date: 09/2017
    • Update Date: 06/14/2017
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