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Intra-Ventricular Hemorrhage
An intraventricular hemorrhage (IVH) is a kind of bleeding that occurs in the brain, starting in the ventricular system and seeping into the area where cerebrospinal fluid is produced.
Boston birth injury lawyers at Jeffrey Glassman Injury Lawyers know that this condition is often caused by some form of physical trauma either during or shortly after birth.
An example often cited is when a physician is negligent in the use of forceps during delivery. It can also sometimes happen if a premature baby with undeveloped lungs is not given the necessary steroid therapy.
These examples highlight two of the biggest risk factors for IVF:
- Premature birth
- Difficult labor
Prematurely-born infants born under 3.3 pounds and those with respiratory distress syndrome and unstable blood pressure are typically the most susceptible. Also, mothers who have suffered high blood pressure, infection or blood-clotting may have increased risk of a child developing this condition. There are some cases in which the condition may develop in full-term babies.
Risk factors for IVH in non-premature infants include:
- Infant stuck in birth canal;
- Forceps used during delivery, resulting in halt of blood flow to the brain;
- Vacuum used during delivery, resulting in reduced blood flow.
Almost all cases of IVH occur within the first few days of an infant’s life. It’s extremely rare after one month of age, even in premature infants.
The result can be irreversible brain damage, including cerebral palsy or the life-threatening hydrocephalus.
Common Symptoms of Intra-Ventricular Hemorrhage:- Bradycardia and apnea (low heart rate and breathing interruptions)
- Changes in blood pressure
- Blue or pale coloring
- Weak suck
- Seizures or other abnormal movements
- Excessive sleep
- Lethargy
- Decreased muscle tone
- Cries that are high-pitched
- Anemia (low blood count)
- Swelling or bulging of fontanelles, or the “soft spots” between the bones of the baby’s head
In some cases, doctors can help to prevent the condition by either doing everything possible to delay a birth that would otherwise be premature and also by using appropriate caution when handling a baby’s head during delivery.
If a fetus is expected to be born prematurely, doctors also have the option in many cases of prescribing glucocorticoids while the mother is still pregnant, which can help to speed up fetal lung maturity, decreasing the risk of IVH.
Regardless of whether a health care provider was responsible for causing IVH, they should generally be able to detect it quickly.
It’s an issue about which clinicians should be hyper-aware. A 2015 study on neonatal hematology published in the journal Clinics in Perinatology revealed, “Neonatologists, pediatricians, nurse practitioners and bedside neonatal caregivers cannot work even one shift in the NICU (neonatal intensive care unit) without encountering hematological problems.”
Knowing that IVH is most often an issue for premature infants, health care providers have to be on especially high alert with this population.
The normal gestational period is 40 weeks. According to a 2009 study published in Clinics in Perinatology, a baby born prior to 30 weeks should undergo an ultrasound of the head to screen for the condition. Infants born between 30 and 34 weeks should also probably undergo screening if they display symptoms of a problem. In many cases, a second ultrasound – closer to the child’s previous due date – may be advisable.
Usually the condition is described in one of four grades, and the category depends on the amount of bleeding:
- Grade I: bleeding in a small area of ventricles
- Grade II: bleeding occurs also inside the ventricles
- Grade III: ventricles are enlarged by blood
- Grade IV: bleeding occurs in the brain tissue around the ventricles
Unfortunately, there is no known way as of this writing to halt the bleeding associated with IVH. However, there may be ways to keep the infant stabilized and minimize the damage.
Examples include:
- Blood transfusions to improve blood count and blood pressure;
- Spinal tap to drain fluid and relieve pressure;
- Surgical placement of a shunt into the brain to drain the fluid.
The prognosis of a child depends on the amount of bleeding that occurs, but also on the swift detection and response of the baby’s medical team.
In cases where an error by health care providers caused IVH or resulted in a failure to detect it early enough to significantly mitigate the damage, parents may have grounds for a medical malpractice lawsuit.
