IVH grade explainer
The short answer
Intraventricular hemorrhage is bleeding into the fluid spaces of the brain, mostly in babies born early. It is described in four grades. 1
The most useful thing to know is that grade IV is not simply a bigger grade III. It is a different event: veins draining the brain tissue become blocked, and that tissue is injured and bleeds. 2
The numbers, up front
- The grading system
- Four grades, described by Papile and colleagues in 1978 and still in use 1
- When it happens
- Most bleeds occur in the first 72 hours after birth, which is why head ultrasounds are scheduled in that window 2
- What grade IV actually is
- A venous infarction of the brain tissue beside the ventricle, properly called periventricular hemorrhagic infarction, rather than an extension of the ventricle bleed 2
- The main complication
- Hydrocephalus, most often after grade III and grade IV, which is why head circumference is tracked 3
- A proven preventive step
- Antenatal corticosteroids before an expected preterm birth reduce the risk of intraventricular hemorrhage 4
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What to track after any grade
Head circumference, measured and plotted. A head crossing upward through percentile lines is often the first sign of hydrocephalus. 3
Repeat scans, to watch ventricle size. Ask for the measurements, not a description.
A term-equivalent MRI, which shows white matter injury far better than ultrasound. Ask whether it is planned. 2
Developmental follow-up, which matters at every grade because very preterm birth carries its own risks separate from the bleed. 5
See intraventricular hemorrhage for the full picture.
Questions parents ask
Is grade IV just a worse grade III?
No, and this is the most common misunderstanding. Grade IV is a different event: veins draining the brain tissue become blocked, and that tissue is injured and bleeds. It affects one side more than the other, which is why it typically leads to weakness on one side rather than symmetric problems. 2
My baby has a grade I bleed. Should I worry?
Grade I bleeding is confined to the germinal matrix and most babies do well. 1 Follow-up scans confirm it has not extended, and developmental follow-up still matters, because being born very early carries risks separate from the bleed. 5
Will my baby need a shunt?
Only some babies do, mainly after grade III or IV where fluid build-up does not settle. Teams usually watch head growth and ventricle size first and use temporary measures before deciding. 3 Ask what they are measuring and what number would change the plan.
Words on this page, in plain English
- intraventricular hemorrhage
- Bleeding into the fluid spaces inside the brain, called the ventricles. It is most common in babies born early.
- hydrocephalus
- Too much spinal fluid inside the brain. The pressure can push on brain tissue.
Where these facts come from
- The Journal of Pediatrics. Incidence and evolution of subependymal and intraventricular hemorrhage. 1978. pubmed.ncbi.nlm.nih.gov/305471/. Link checked September 3, 2026.
- Elsevier. Volpe's Neurology of the Newborn, Sixth Edition. 2018. www.elsevier.com/books/volpes-neurology-of-the-newborn/volpe. Link checked September 3, 2026.
- National Institute of Neurological Disorders and Stroke. Hydrocephalus. 2025. www.ninds.nih.gov/health-information/disorders/hydrocephalus. Link checked September 3, 2026.
- Cochrane Database of Systematic Reviews. Antenatal corticosteroids for accelerating fetal lung maturation. 2020. www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004454.p. Link checked September 3, 2026.
- American Academy of Pediatrics, Pediatrics. Hospital Discharge of the High-Risk Neonate. 2008. publications.aap.org/pediatrics/article/122/5/1119. Link checked September 3, 2026.