What are the different levels of brain bleeds? What do they mean for a baby’s future?

Bleeding in the brain is also called intraventricular hemorrhage (IVH). It is most common in the smallest premature babies (those weighing less than 3 1/3 pounds). The bleeds usually occur in the first four days of life. Bleeding generally occurs near the fluid-filled spaces (ventricles) in the center of the brain. Symptoms of a brain bleed may include:

• A weak suck while feeding
• A high-pitched cry
• Apnea (a long pause in breathing)
• Bradycardia (a slow heart rate)
• Anemia (low number of red blood cells, which means less oxygen to the brain and tissues)

Brain bleeds usually are given a number from 1 to 4. The most severe is 4; the least severe is 1. An ultrasound examination can show whether a baby has had a brain bleed and how severe it is.

Most brain bleeds are mild (grades 1 and 2) and resolve themselves with no or few lasting problems. More severe bleeds can cause difficulties for the baby during hospitalization and possible complications in the future. Some bleeds will require careful monitoring of the baby's development throughout infancy and childhood. There isn't a specific treatment for brain bleeds. Most babies are carefully monitored. Surgery may be necessary if fluid builds up in the brain. Infants with serious brain bleeds may be at risk for neurological conditions (conditions related to the brain and nervous system), like cerebral palsy or seizures, later in life.

January 2007