One page summary: Intraventricular hemorrhage (IVH), grades I to IV

In two sentences

Intraventricular hemorrhage, or IVH, is bleeding into the ventricles, the fluid spaces inside the brain. It happens mostly in babies born early, and it usually starts in the first three days of life. ¹

It is described in four grades. Grades I and II are small bleeds and most babies do well. Grades III and IV are larger and carry a real risk of hydrocephalus and lasting effects. The grade is the first thing to ask for, and the second is what the follow-up scans show. ¹

The numbers, with their sources

• Where it starts. In the germinal matrix, a fragile layer of blood vessels present in premature babies that normally disappears by about 34 weeks of pregnancy ²
• When it happens. Most bleeds occur in the first 72 hours after birth, which is why head ultrasounds are done on a schedule in that window ²
• The grading system. Four grades, described by Papile and colleagues in 1978 and still in use ¹
• Who is at risk. Risk rises the earlier and smaller the baby. It is uncommon in babies born at term ²
• How it is found. Cranial ultrasound through the soft spot, repeated on a schedule in very preterm babies ²
• A proven preventive step. Antenatal corticosteroids given before an expected preterm birth reduce the risk of intraventricular hemorrhage ³

What to do this week

1. Ask for the grade, the side, and the date of every scan. Ask for copies of the reports.
2. Ask whether the ventricles are enlarging and what the plan is if they do.
3. Ask for daily head circumference measurements and ask to see them plotted.
4. Ask whether a term-equivalent MRI is planned.
5. Ask whether antenatal steroids were given before the birth.
6. Refer to early intervention now.
7. If a shunt is placed, write down the type, the date, the surgeon, and the warning signs and put it in your phone.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the neonatologist

• What grade, which side, and on what day was it found?
• Has it changed on repeat scans?
• Are the ventricles enlarging? What number are you watching?
• Is a term-equivalent MRI planned?
• Were antenatal steroids given before delivery?

For the neurosurgeon

• At what point would you place a shunt, and what happens if we wait?
• What kind of shunt, and what should we watch for at home?
• What are the signs of a blockage, and who do we call at 2 a.m.?
• How often will this need checking as my child grows?

For the neurologist or follow-up clinic

• What are you watching for at each visit?
• What would make you think about cerebral palsy?
• Is there a seizure risk, and what would a seizure look like?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Intraventricular hemorrhage (IVH), grades I to IV

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.