Brain Bleeds in a Baby: Intraventricular Hemorrhages (IVH)
Baby Brain Injury Attorneys & Intraventricular Hemorrhage (Brain Bleed) Lawyers Representing Families in Michigan & all 50 States
When parents are told their newborn baby has a brain injury, they have many questions about the causes and long-term consequences for their child. Brain damage in a baby can be caused by a brain bleed. The most common type of brain bleed in a newborn is an intraventricular hemorrhage (IVH). If improperly managed, intraventricular hemorrhages can cause permanent brain damage and conditions such as hydrocephalus, cerebral palsy, periventricular leukomalacia (PVL – usually seen in premature babies), seizure disorders, intellectual disabilities and developmental delays. In this article, we discuss IVH, its causes and treatments, and what the short and long-term outlook may be for a baby who has IVH.
AWARD WINNING BIRTH INJURY & INFANT BRAIN BLEED LAWYERS HELPING CHILDREN WITH BRAIN INJURIES FOR ALMOST 3 DECADES
The award winning birth injury lawyers at Reiter & Walsh ABC Law Centers have helped dozens of children affected by brain bleeds and brain injury. Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 29 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
WHAT IS AN INTRAVENTRICULAR HEMORRHAGE (BRAIN BLEED) & WHAT CAUSES IT?
An intraventricular hemorrhage (brain bleed) is bleeding inside the brain’s ventricles. This bleeding can be caused by a lack of oxygen to the baby’s brain and brain trauma. Premature babies are more susceptible to IVH because blood vessels and other parts of their brains are fragile. Oxygen deprivation can cause bleeding because when the brain receives insufficient oxygen, cells start to degrade. When the cells that make up the blood vessel walls start to break down, the vessels become fragile and can rupture very easily. Traumatic head injury is often caused by the use of forceps and vacuum extractors to assist with delivery. These devices are placed directly on the baby’s head when the baby is in the birth canal and they place the baby at a significant risk of having a brain bleed. Conditions that can cause IVH are discussed below.
Causes of Intraventricular Hemorrhages in a Term or Preterm Baby
- Hypoxic ischemic encephalopathy (HIE – brain injury caused by a lack of oxygen or blood flow to the brain)
- Abnormal changes in blood pressure
- Trauma from prolonged labor. The stresses and forces of labor are traumatic for a baby. Many conditions can cause prolonged labor, and oftentimes, physicians fail to move on to C-section delivery when it is medically necessary. During an extended attempt at vaginal delivery, the physician may use Pitocin or Cytotec to try and speed up delivery, or vacuum extractors and forceps may be used to try and facilitate delivery. All of these actions can cause a traumatic injury to the head with resultant brain bleeding.
- Trauma from a difficult birth, which can occur when a baby is large for her gestational age (macrosomic), the mother’s pelvis is too small for the size of the baby (CPD), or forceps or vacuum extractors are used to facilitate delivery
- Oxygen deprivation or head trauma from hyperstimulation caused by Pitocin or Cytotec
- Abnormal presentation, such as a breech or face presentation, that cause head trauma. Research shows that a C-section delivery is the safest way to deliver a baby in breech presentation.
- A lack of oxygen to the baby’s brain and HIE are significant causes of IVH. There are numerous events that can occur during or near the time of delivery that can cause a baby to experience oxygen deprivation and develop HIE. These events include the following:
- Umbilical cord compression, which can occur when the baby has umbilical cord prolapse, nuchal cord (cord wrapped around baby’s neck), a short umbilical cord and a cord in a true knot.
- Placental abruption
- Uterine rupture
- Prolonged labor
- Use of Pitocin or Cytotec
- Placenta previa
- Oligohydramnios (low amniotic fluid)
HOW DO INTRAVENTRICULAR HEMORRHAGES (BRAIN BLEEDS) CAUSE BRAIN DAMAGE & HOW CAN IVH AFFECT MY CHILD LONG-TERM?
As with any brain bleed, an intraventricular hemorrhage can damage the brain by causing a decreased amount of oxygen-rich blood in certain areas. If recognized right away and properly managed, IVH may cause no permanent injury in the baby. If not properly managed, however, the hemorrhage can extend into other areas of the brain. Specifically, the ventricles can swell due to too much cerebral spinal fluid, which is called hydrocephalus. Hydrocephalus can lead to damaged blood vessels and destruction of white matter in the brain, and an important part of the brain, called the cerebral cortex, may not develop properly.
White matter is important because it regulates the electrical signals between cells of the nervous system. White matter is responsible for transmitting information throughout the brain, to the spinal cord, and outside the brain to the rest of the body. These signals control our bodily functions; nerve cells that transmit signals to the brain and cells that regulate breathing or heart rate would be unable to perform their tasks without white matter. In short, IVH can cause brain damage by disrupting the dynamics of cerebral spinal fluid which then causes the ventricles to swell, which can then cause the baby to have hydrocephalus.
The cerebral cortex plays a key role in memory, attention, thought, language and consciousness. IVH and hydrocephalus can cause a child to have lifelong conditions such as seizures, cerebral palsy and developmental delays that affect reasoning, memory, speech or other learning and communication abilities.
WHAT ARE THE RISK FACTORS FOR INTRAVENTRICULAR HEMORRHAGES & BRAIN BLEEDS IN A BABY?
IVH occurs most frequently in babies who are less than 32 weeks of gestation or have a birth weight of less than 1500 grams. Other risk factors for IVH include birth asphyxia, hypoxia, hypoxic ischemic encephalopathy (HIE), trauma, lack of prenatal steroid therapy to help prevent IVH, prolonged neonatal resuscitation and respiratory distress.
WHAT ARE THE SIGNS OF INTRAVENTRICULAR HEMORRHAGES & BRAIN BLEEDS IN A BABY?
Listed below are some signs that the baby may have IVH.
- An altered level of consciousness
- The baby is limp (hypotonia) and/or weak
- The baby has decreased movement
- The baby’s breathing is abnormal – in severe cases, the baby is not breathing enough, has irregular breathing, and/or has periods in which she stops breathing (apnea)
- The baby has seizures, especially tonic seizures
- The baby is showing neurological signs, such as her pupils being fixed to light
- The baby’s heart rate is slow and/or her blood pressure is low
- The baby has a bulging soft spot
- The baby’s red blood cell count (hematocrit) is decreasing
- The baby’s blood is acidic (acidosis)
- The baby is in a coma
HOW ARE INTRAVENTRICULAR HEMORRHAGES & BRAIN BLEEDS IN A BABY DIAGNOSED & TREATED?
Intraventricular hemorrhages are diagnosed with a head (cranial) ultrasound. Physicians use the ultrasound to determine the location and extent of the IVH.
Grading of the severity of the IVH is as follows:
- Grade I – Bleeding is confined to the germinal matrix, which is very important in brain development; cells migrate out of this area during brain development and the germinal matrix is most active between 8 & 28 weeks of gestation
- Grade II – Bleeding is occurring inside the ventricles, but they are not enlarged
- Grade III – The bleeding has caused the ventricles to become enlarged
- Grade IV – Bleeding extends into the brain tissue around the ventricles; there is some tissue death in the periventricular white matter next to the IVH
Since IVH occurs most frequently in babies who are less than 32 weeks of gestation or have a birth weight of less than 1500 grams, all babies who are less than 30 weeks or 1500 grams should have ultrasounds to screen for IVH.
Treatment for blood loss includes giving the baby blood and other therapies to increase blood volume and blood pressure. This includes packed red blood cells, fresh frozen plasma, and normal saline.
Initial management of IVH requires ongoing monitoring with weekly ultrasounds, daily recording of head size, and clinical assessment for signs of increased pressure in the brain. Additional management typically includes lumbar punctures to drain cerebral spinal fluid. If this is not effective, the baby may need to have ventricular drainage or shunting.
REITER & WALSH: ADVOCATES FOR BABIES WHO HAVE BRAIN BLEEDS & BRAIN INJURIES FOR ALMOST 3 DECADES
If you are seeking the help of an infant brain injury lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a birth injury law firm that has been helping children throughout the nation for almost 3 decades.
Birth injury lawyer Jesse Reiter, president of the firm, has been focusing solely on birth injury cases for over 29 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. The partners of the firm, Mr. Reiter and Rebecca Walsh, were recently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report. In fact, U.S. News and World Report has given Mr. Reiter the honor of being one of the “Best Lawyers in America” every year since 2008. The brain injury lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a permanent disability, such as hypoxic ischemic encephalopathy (HIE), cerebral palsy, periventricular leukomalacia (PVL), a seizure disorder or developmental delays, the award winning birth injury lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award winning birth injury lawyers are available 24 / 7 to speak with you.
VIDEO: INTRAVENTRICULAR HEMORRHAGES IN A BABY / INFANT BRAIN BLEEDS & BRAIN INJURY
Watch a video of infant brain bleed lawyer Jesse Reiter discussing the many causes of seizures in a baby. Causes include brain bleeds and hemorrhages and hypoxic ischemic encephalopathy (HIE).
- Adcock LM. Clinical manifestations and diagnosis of intraventricular hemorrhage in the newborn. In: UpToDate. Kim MS (Ed), UpToDate, Waltham, MA, 2014.
- Owens R. Intraventricular hemorrhage in the premature neonate. Neonatal Netw 2005; 24:55.
- Kenet G, Kuperman AA, Strauss T, Brenner B. Neonatal IVH–mechanisms and management. Thromb Res 2011; 127 Suppl 3:S120.
- Volpe JJ. Intracranial hemorrhage: Germinal matrix-intraventricular hemorrhage. In: Neurology of the Newborn, 4th ed, WB Saunders, Philadelphia 2001. p.428.
- Elimian A, Garry D, Figueroa R, et al. Antenatal betamethasone compared with dexamethasone (betacode trial): a randomized controlled trial. Obstet Gynecol 2007; 110:26.
- Volpe JJ. Intracranial hemorrhage: Germinal matrix-intraventricular hemorrhage. In: Neurology of the Newborn, 5th ed, Saunders, Philadelphia 2008. p.517.