Intraventricular hemorrhage (IVH) in preterm infants refers to the entry of blood into the cavity within the brain called the ventricle. One of the characteristics of an immature brain is that the blood vessels that connect to the ventricles are very fragile. The ventricles are the cavities that store the cerebrospinal fluid (CSF) that nurtures the brain. The area of the brain adjacent to the ventricles (also known as the germinal matrix) is very thin and fragile, making it a vulnerable site for IVH. The germinal matrix is an active area of the brain during embryonic development and disappears at about 35 weeks of gestation. These vessels are very thin and susceptible to fluctuations in intravascular blood flow, and thus may rupture and bleed. The younger the age and size of the baby, the greater the likelihood of rupture of the blood vessels, which usually occurs in the first few days of life. The rupture of a blood vessel causes blood to flow into the ventricles of the brain. The concept of ventricles There are four ventricles in the human brain, with two lateral ventricles in the left and right cerebral hemispheres → the third ventricle is in the center of the brain → the fourth ventricle is between the brainstem and the cerebellum → cerebrospinal fluid is produced in the ventricles → cerebrospinal fluid flows sequentially from the lateral ventricles, the third ventricle, and the fourth ventricle into the cerebrospinal membrane layer between the outer layers of the brain and spinal cord. Cerebrospinal fluid is also reabsorbed in this part at the same time. → The brain and spinal cord float in the cerebrospinal fluid, which provides nutrition and protection for the brain and spinal cord. Intraventricular hemorrhage (IVH) is graded into four classes: I and II are mild, and III and IV are severe. Approximately 50% of extremely immature preterm infants with IVH will survive. If the IVH is grade I or II, there is a low chance of long-term damage. With grade III intraventricular hemorrhage (IVH), excessive bleeding causes swelling or blockage of the tiny blood vessels that connect to the ventricles. It may also interfere with the normal replenishment and circulation of cerebrospinal fluid (CSF), causing CSF to become trapped in the ventricles, leading to hydrocephalus, excessive pressure on the tissues surrounding the brain, and eventually brain damage due to the pressure. If the hemorrhage is severe, the blood that has flowed into the ventricles and filled them can permanently block the flow of cerebrospinal fluid (CSF), causing hydrocephalus, head enlargement, and excessive intracranial pressure, which often requires surgery to relieve the pressure. A ventriculoperitoneal shunt (VP shunt), in which a thin tube or catheter is inserted into the brain to drain the cerebrospinal fluid, is now commonly used. In children with grade IV intraventricular hemorrhage (IVH), the more severe intraventricular hemorrhage results in pressure on the brain tissue surrounding the ventricles, which reduces blood flow to the damaged brain tissue. The result is often lasting brain damage, the severity of which varies depending on the extent and location of the bleeding. Because of the fragility of blood vessels in preterm infants, simple changes in blood pressure and blood flow at birth can trigger intraventricular hemorrhage (IVH). Although most people do not bleed with changes in blood pressure, the blood vessels of preterm infants have thin walls and are prone to rupture with changes in blood pressure. Blood pressure fluctuations can have a variety of causes, often caused by obstructed labor or pulmonary and respiratory complications. Premature babies are often born immediately after birth with the aid of mechanical ventilation, and this can also lead to blood flow fluctuations. Especially when the baby’s spontaneous breathing is not synchronized with the ventilator, there is a high risk of fluctuations in blood pressure, which in turn leads to increased pressure in the blood vessels in the lungs and brain. The recent advent of newer ventilators with synchronized triggering has generally reduced the incidence of this condition. …… Intraventricular hemorrhage (IVH) bleeding usually occurs in the first 7 days of life, especially in the first 72 hours, and is less likely to occur thereafter. Intraventricular hemorrhage (IVH) can cause damage in two main ways: first, IVH may affect the flow of cerebrospinal fluid (CSF) in the ventricles; second, IVH may cause damage to the brain tissue near the ventricles. Once damage to brain tissue has occurred, it is difficult for this damage to heal. However, physical damage to brain tissue does not necessarily mean that brain function is harmed. The part of the brain near the ventricles that is responsible for motor function is often affected by intraventricular hemorrhage (IVH). This usually affects vision, hearing, or other higher perceptual functions. The extent of long-term effects often depends on the severity of the hemorrhage: infants with severe intraventricular hemorrhage (IVH) may develop some kind of neurological disorder. A common one is cerebral palsy (CP), in which motor coordination is involved. But people with cerebral palsy have various forms of disability: people with hemiplegia have only one side of their body affected, and children with mild spastic diplegia have only their legs affected and can often walk with the help of crutches. Fortunately, most infants with mild intraventricular hemorrhage (IVH) are able to develop normally or have only mild learning disabilities. Because IVH can be caused by injury, if IVH is suspected, doctors will look for signs of premature birth (such as obstructed and delayed labor) and infection, which may also indicate IVH. Although IVH may not have initial signs, seizures, major clinical decline with anemia, hypotension, and metabolic acidosis may be symptoms. Sometimes, preterm infants with IVH may appear to be slow-growing and generally ill. Diagnosis can be confirmed with an ultrasound of the brain. Anemia, metabolic acidosis, and infection may be tested with other tests, including blood tests. If intraventricular hemorrhage (IVH) is diagnosed, the condition is classified as grade I to IV, with grade IV being the most severe.