Medical Malpractice
Intraventricular hemorrhage (IVH) is a type of brain bleed that some babies develop shortly after being born. IVH occurs when blood vessels in a baby’s brain start to bleed into the spaces that hold cerebrospinal fluid, known as the ventricles.
The cause of IVH is not fully understood, but premature babies and babies who suffered an injury during delivery are at a higher risk of acquiring the condition. There is currently no way to stop the bleeding from IVH once it starts, but in most cases, the problem will resolve itself over time as the baby’s blood vessels continue to strengthen. Treatment mainly focuses on stabilizing the patient and reducing any side-effects caused by the bleeding. However, if the IVH is severe enough or is left untreated, it can lead to permanent brain damage.
What are the Causes of IVH?
Doctors are still trying to understand the underlying causes of IVH. So far, it’s been determined that the condition occurs most often in premature babies. Infants born more than 10 weeks early appear to be at the highest risk of developing IVH. This may be due to the baby’s blood vessels not being fully developed at the time of birth, causing them to be fragile and easily ruptured. Babies who experience respiratory problems, unstable blood pressure, or other medical conditions after being born are also at an increased risk of the condition. Most cases of IVH happen within the first four days of life and the condition rarely develop after the first month.
There is a great deal of evidence to suggest that some cases of IVH are caused by excessive force during vaginal delivery. The use of forceps or vacuums during delivery can put excessive pressure on the brain and result in bleeding. When a baby gets stuck in the birth canal due to complications during labor, doctors have to react quickly to deliver them in time. This can cause the doctors to panic and improperly handle the baby while trying to save them.
What are the Different Grades of IVH?
IVH is separated into four different categories called “grades” based on the degree of bleeding in the brain.
- Grade 1: Bleeding occurs in a small, localized area of the brain (also called germinal matrix hemorrhage)
- Grade 2: Bleeding also occurs inside the ventricles
- Grade 3: The bleeding begins to put pressure on the brain and the ventricles became enlarged with blood
- Grade 4: Bleeding extends into brain tissues around the ventricles (also known as intraparenchymal hemorrhage)
Grades 1 and 2 are the most common forms of IVH and usually do not present any lasting complications after the bleeding stops. Grades 3 and 4 are considered more serious and can result in brain damage if left untreated. When there is extensive bleeding enlarging the blood vessels, it could cause blood clots that prevent the flow of cerebrospinal fluid. Babies with severe IVH may develop hydrocephalus, which is a buildup of excessive cerebrospinal fluid in the brain.
What are the Symptoms of IVH?
There may be no obvious signs that a baby has IVH. Many babies do not present symptoms unless the condition is starting to cause complications. Additionally, IVH symptoms can often be confused for other common illnesses. The most common symptoms include
- Apnea (pauses in breathing)
- Bradycardia (low heart rate)
- Pale or blue skin color (cyanosis)
- Weak suck
- High-pitched cry
- Seizures
- Anemia (low blood count)
- Changes in blood pressure
- Decreased muscle tone
- Decreased reflexes
- Excessive sleeping
- Swelling of the baby’s head
If your baby was born prematurely and starts exhibiting signs of IVH, it’s important to take these symptoms seriously and consult with a doctor as soon as possible.
How are Babies Diagnosed With IVH?
To diagnose IVH, the doctor will first start with going over the child’s medical history and conduct an initial physical examination. If there’s a possible risk of IVH, a cranial ultrasound will be given, which is a test that uses soundwaves to create a picture of the inside of the baby’s skull.
The ultrasound will be able to quickly identify if there is any bleeding in the brain. All babies born before 30 weeks should be given an ultrasound within 1 to 2 weeks of life to screen for IVH due to their increased risk. Premature babies may also require a second screening around the time of their original due date to make sure the blood vessels are developing properly.
How do You Prevent and Treat IVH?
Once IVH begins, there is no way to stop the bleeding. While this may sound concerning, most babies with IVH will make a full recovery with no long-term effects. As their brain continues to develop, the blood vessels can strengthen and heal themselves.
Treatment is mainly focused on keeping the baby’s vitals stable and managing any additional symptoms. Severe cases of IVH may require surgery if there is too much pressure on the brain from excess cerebrospinal fluid. In these cases, a shunt can be implanted into the skull to allow the fluid to drain.
Women who are at risk of early labor are often prescribed corticosteroids to help prevent IVH. These steroids are given between 24 and 34 weeks gestation. Women using medications that may affect bleeding risks can be given vitamin K before delivery, which helps the blood’s clotting ability. When a premature baby is born, the doctors may not immediately clamp the umbilical cord as it has been shown to also reduce the risk of IVH.
What is the Prognosis of a Child With IVH?
The prognosis of a child will depend on what grade of IVH they had. Most babies with grade 1 or 2 IVH will survive with no type of damage to the brain. Babies with a grade of 3 or 4 face a higher mortality risk, with up to 50% of children dying from the hemorrhage.
Grade 4 IVH is significantly associated with long-term disability and the diagnosis of cerebral palsy. As long as IVH is detected and treated early, the prognosis for a baby is usually very promising. If the IVH is allowed to progress without any medical intervention, however, it carries the risk of permanent cognitive impairment.
IVH Settlements and Verdicts
- FS v Mount Sinai Hosp. (New York 2024) Verdict $5,048,961: Mother developed a GSB infection at 22 weeks and chorioamnionitis was diagnosed at 24 weeks. The defendants opted to deliver via C-section at 24 weeks. The baby was born suffering from severe hypoxic exposure and metabolic and respiratory acidosis. An intraventricular hemorrhage went unnoticed for six days, at which time it had advanced to a grade IV level. The baby was diagnosed with cerebral palsy with speech and cognitive impairments. The lawsuit asserted delay of diagnosis of the mother’s infection and the development of chorioamnionitis, and failure of staff to notice of the IVH.
- EA v Univ of Maryland (Maryland 2023) Verdict $33,915,000: Pregnant woman went the hospital at 23 weeks gestation complaining of abdominal cramps. The defendant OB/GYN mistakenly diagnosed her with placental abruption and ordered an emergency c-section delivery. The baby was born with catastrophic brain damage including intraventricular hemorrhage and periventricular leukomalacia, resulting in cerebral palsy, developmental and cognitive delays and delays in fine and gross motor skills.
- JP v NYC Health (New York 2017) Settlement $2,750,000: Plaintiff, newborn male, suffered intraventricular hemorrhage causing permanent and severe brain impairment and leaving him paralyzed. He sued the hospital where he was born claiming that that delivery team was negligent in failing to timely diagnose placental abruption and perform an immediate emergency C-section in response. Defendant hospital denied any wrongdoing but eventually agreed to settle the case for $2.75 million.
- Dixon v Lantz (South Carolina 2017) Settlement $600,000: Infant male plaintiff reportedly suffered an intraventricular hemorrhage (IVH) during his delivery and birth, performed by defendant OB/GYN. Plaintiff alleged that defendant failed to properly interpret tracings on fetal monitoring strips and neglected to intervene with an emergency C-section when plaintiff’s heart rate rapidly decelerated. Plaintiff’s IVH left him with a permanent seizure disorder. Liability was contested but the case was eventually settled for $600,000.
- Chang v Ahmadinia (California 2017) Settlement $3,500,000: A newborn female allegedly developed an intraventricular hemorrhage (IVH) and periventricular leukomalacia when she was delivered prematurely at 26 weeks gestation. She was diagnosed with spastic cerebral palsy and epilepsy. Plaintiff alleged that defendant OB/GYN violated the standard of care by failing to diagnose and treat her mother’s bowel obstruction, failing to identify her mother’s herniated bowel and bowel obstruction from an ultrasound. This negligence reportedly led to plaintiff’s premature delivery and resulting birth injuries. Case settled for $3.5 million.
- Yanak v Cambridge (Pennsylvania 2016) Verdict $8,490,346: Male infant was one of a set of identical twins who suffered from Twin to Twin Transfer Syndrome (TTTS) and were delivered very prematurely. His twin brother did not survive birth. Defendant doctors allegedly failed to properly monitor infant after birth and he suffered cardiac arrest resulting in severe intraventricular hemorrhage (IVH) causing permanent disability requiring 24-hour inpatient care. Defendants were accused of negligence in failing to adequately staff the NICU and failing to transfer the mother to a more capable hospital. The jury awarded $8.4 million in damages.
Contact Miller & Zois About IVH
If your baby experienced complications related to IVH that caused permanent brain injury, you may be entitled to compensation from the doctors or hospital. Contact the birth injury lawyers at Miller & Zois to discuss your case. Call at 800-553-8082 or contact us online.
Studies & Research
Li, Dongyu, et al. “Photostimulation of brain lymphatics in male newborn and adult rodents for therapy of intraventricular hemorrhage.” Nature Communications 14.1 (2023): 6104.
Tsao, Pei-Chen. “Pathogenesis and Prevention of intraventricular hemorrhage in preterm infants.” Journal of Korean Neurosurgical Society 66.3 (2023): 228.