If a hemorrhage occurs in the brain in infants before, during, or shortly after birth, several parts of the brain that are important for development and motor skills can become impaired. Known as an intracranial hemorrhage (IVH), this type of brain injury comes in four grades, depending upon the severity of the injuries. There are two types of in intracranial hemorrhaging: arterial bleeding, in which there is loss of oxygen to the issues that carry blood to the heart, and venous bleeding, a hemorrhage that affects the veins that are responsible for returning blood to the heart.
The four grades of IVH range from Grade I-IV, with the latter being the most severe. Both Grade I and II are typically marked by bleeding in minutes amounts in the ventricles. Grade I and II usually don’t pose serious long-term problems and infants will naturally heal. Grade III and IV, however, are marked by excessive bleeding, which in turn can create obstructions in the brain and swelling. If the swelling and obstruction become too severe, hydrocephalus may occur, leading to high-pressure in the brain that usually takes surgery to treat. In addition, the pressure on the brain puts infants and children at high-risk for developing cerebral palsy (CP).
Although IVH is more common in infants who are born prematurely, there are several other risk factors and causes that may contribute to the injury, including:
- Infant stroke
- Blood clots in the placenta
- Maternal hypertension and/or infection, including pelvic inflammatory disease
- Traumatic head injuries
- Malformed or underdeveloped blood vessels in the brain
- Trauma from prolonged labor
- Large infant size and weight (macrosomia)
- Improper delivery methods, such as twisting or pulling the infant too hard
- Improper use of birthing tools
Signs and Symptoms of IVH
One of the first noticeable signs of IVH is extremely lethargy. The infant may seem extremely tired and unresponsive. Other signs and symptoms include:
- Drop in blood count
- Skin may be pale or blue in color
- Weak muscle tone
- Weak reflexes
- Difficulties in sucking
- Elevated bilirubin
- Retinal bleeding
When any of the aforementioned symptoms surface, physicians usually perform brain injury tests such as an MRI or a CT scan in order to determine if there is blood in the skull. In some instances, physicians may also conduct an ultrasonography, and follow up with subsequent ultrasounds should a problem be found. If bleeding is indeed found yet it’s relatively minor, in most cases it will heal on its own. However, as mentioned earlier, the higher grades of IVH pose a series of health risks and the infant will usually need to undergo neurosurgery.
Along with CP, other long-term complications include intellectual and cognitive disabilities. Yet, the prognosis will greatly depend upon the individual circumstances and how severe the injury is. While some children will go on with little or no effects, others will suffer from a range of permanent disorders.