PAM FOD #7 - Preemie complications: Brain bleeds (IVH)

Prematurity Awareness Month
Fact of the Day
Day 7

Q: What's a risks for a micro-preemie's brain, being born so soon?

A: About 30% of babies born at less than 1000 grams (or less than 2 lbs 4 oz) have brain bleeds, or an intraventricular hemorrhage (IVH). This is due to the weak vessels in the baby's brain being exposed to the changes in oxygen levels and blood flow (like with ROP), and (in the case of the brain) causing blood vessles to break. These come in a range of severity (Grades 1 through 4, with a grade four brain bleed being the worst). Some babies have bleeds present at an early ultrasound just after birth. Jonathan didn't, but at a scan prior to his NICU discharge, he showed to have one resolving grade one brain bleed.  This probably happened sometime during his NICU stay, and (like I said) is not uncommon. The smaller the preemie, the more likely.  In 90% of the cases, the bleed resolves with few to no problems. It can, however, impact a preemie for life if it damages an area of the brain too severely.

Two things to remember:

1. Preemies are fragile

2. Preemies are resilient

If you're here because your computer led you here when you did a web search for brain bleeds, know that I'm not a doctor. Just a NICU mom. So, if your baby has a bleed, talk to your doctor.

What I want to mention as a preemie mom is that it isn't anyone's fault. If your baby has an IVH of any degree, don't blame yourself, doctors, or anyone else. Remember, these babies are fragile. But they're also resilient. Yours may be one of the 10% of cases that struggle from the brain bleed later into life. Or maybe not. Time will tell.

What my doctor mentioned, before the first brain scan results even came in, is that the brain scan is not prescriptive. It doesn't tell you what will happen. It gives you a fuller picture of your baby, but that is it. Babies can have severe brain bleeds that clear up well, with no long term issues (resilient as they are, always making new connections), or those bleeds may cause problems like cerebral palsy or seizures. You won't know what the impact is until your baby grows.

Here's a more reliable source on brain bleeds.  And, as always, if this concerns you, ask your NICU doctor.

Jonathan's bleed was small, but it still may cause problems. He has low muscle tone, but we doubt it's cerebral (brain) based. That said, he is followed by early intervention specialists and will be until he's at least two years old. These specialists help us discover problems early on so that we can redirect him and make sure he succeeds as well as he can. One year out and we can guess that his IVH won't cause long term problems, but we can't yet know.