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When a baby develops a hemorrhage in the brain either before birth or shortly after birth, parts of the brain responsible for motor development and the development of skills may become compromised, which can lead to cerebral palsy. This type of bleeding, known as intraventricular hemorrhage (IVH), comes in four categories of injury, with Grade 1 being the least severe. 
Causes of IVH
There are a variety of factors that can contribute to a heightened risk of an infant developing IVH, including:
- Placental problems, such as placenta previa or blood clots in the placenta
- Infant stroke
- Neonatal transport
- Trauma during labor, such as head injuries
- Mechanical ventilation, episodes of respiratory distress, or oxygen deprivation 
- Macrosomia (large baby)
- Medical negligence when using birth-assisting tools, such as forceps
- Maternal infection or hypertension
- Unstable infant blood pressure
- Prematurity or very low birth weight
- Head injury
- Vitamin K deficiency
The greatest independent risk factor for IVH is prematurity, and thus the incidence is much less in full-term infants. Cases of IVH in term babies are usually related to lack of oxygen or birth trauma.
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Symptoms of IVH
In some cases, the presentation may be “silent,” meaning infants may not exhibit any symptoms at all, but other times, symptoms may include:
- Abnormal blood pressure and heart rate
- Pauses in breathing
- Decreased reflexes and muscle tone
- Fatigue and excessive sleep
- Abnormal body movements
Severity of IVH
Cases of intraventricular hemorrhage are graded based on the severity of the bleeding within the brain and the amount of brain tissue that is affected.
Grade I IVH
Grade I is the mildest form of IVH, and in most cases, the bleeding is minimal with no long-term problems. In grade I injury, the bleeding is mostly contained in the germinal matrix, which is the area just around the ventricles.
Grade II IVH
Grade II is still considered a relatively mild form of IVH, but slightly more serious than grade I and involves between 10 and 50% of the ventricles. However, similar to grade I bleed, there is usually less concern for long-term problems.
Grades III & IV IVH
The most severe forms of IVH, grades III & IV, are marked by substantially more bleeding in the brain, with grade IV being the most severe.
These forms of IVH usually result in more symptoms, and the infant will have a greater risk of long-lasting effects from injury to the brain tissue.
In these higher grades of IVH, the bleeding and swelling can cause a condition known as hydrocephalus, which is marked by an increased amount of fluid in the brain and enlargement of the ventricles. In addition, Grades III and IV IVH can lead to blood pressure changes, resulting in a possible rupture of blood vessels if not treated in time.
Generally, diagnosis occurs after a physician detects that blood has reached the ventricles. This can be done with an ultrasound, which is the most common method for determining the presence of a bleed (and is often part of routine care in very premature infants because the risk for them is so high). With ultrasound views, the grade of bleed can usually be identified. An MRI is an even more sensitive study to diagnose IVH, especially the milder forms that may not show up as well on ultrasound.
Although it is not possible to prevent all forms of IVH, physicians will try to keep the baby as calm and stable as possible with very close and continuous monitoring. In more severe cases, a blood transfusion may be needed, a spinal tap to reduce swelling, or a ventilator to assist with breathing. 
In most instances, babies with grade I IVH will not experience developmental delays or develop cerebral palsy, although the risk is always there.  Most infants in this category of hemorrhage, however, will heal and improve without any long-term damage. As the grade of bleed increases, the risks of effects on growth and development increase. The baby will then need specialized care and therapy, as well as possible surgery to correct the fluid imbalances in the ventricles.
It’s ideal to deliver an infant as close to their due date as possible, as babies born prematurely run the highest risk of developing IVH.
Although it’s not always possible to carry a pregnancy to term, there are a number of things you can do to lessen the risk of delivering your baby prematurely, including the following recommendations:
- Keep all medical appointments and get routine prenatal care.
- Do not drink alcohol, smoke, or use illicit drugs while pregnant.
- Maintain a healthy, nutritious diet.
- If you are at a high risk of delivering early, consult with your physician about how and where the delivery should take place, and any precautions or special care that might be needed.
- Ask your doctor about taking vitamin K if you are taking medications that may promote bleeding.
- Periventricular/Intraventricular Hemorrhage (PVH/IVH) in the Premature Infant. (n.d.). School of Medicine | Emory School of Medicine.
Retrieved from: https://med.emory.edu/departments/pediatrics/divisions/neonatology/dpc/pvhivh.htm
- Intraventricular Hemorrhage Symptoms & Causes. (n.d.). Boston Children's Hospital.
Retrieved from: https://www.childrenshospital.org/conditions-and-treatments/conditions/i/intraventricular-hemorrhage/symptoms-and-causes
- Management of Intraventricular Hemorrhage. (n.d.). PubMed Central (PMC) National Institutes of Health.
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138489/
- Radic JA , et al. (n.d.). Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of... - PubMed - NCBI. National Center for Biotechnology Information.
Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26030329