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Preemie Brain Bleeds

By Nicole Zimmerman, author of The NICU Rollercoaster

A preemie mom discusses brain bleeds in preemies, sharing her experience in the NICU and providing background information.

One of our concerns with our twin preemie Ronan was bleeding in his brain or intraventricular hemorrhage. Dr. Patricia Bromberger, MD, a neonatologist at Kaiser Permanente states that an intraventricular hemorrhage (IVH) is a type of bleeding from fragile blood vessels in the brain. These blood vessels are especially fragile in premature infants. Babies born more than eight weeks early are most likely to have this bleeding.

Some fragile blood vessels surround the ventricles of the brain, cavities in the brain though which cerebrospinal fluid (CSF) flows. The blood vessels are underdeveloped in the very young infant. They start getting stronger after thirty-two weeks of gestation. These blood vessels are very sensitive to changes in blood flow. If the blood flow changes, the blood vessels break down and start bleeding. If the bleeding is slight, the blood remains around the blood vessels. If the bleeding gets worse, the blood breaks into the ventricles. In the worst cases of bleeding, the blood may leak into the brain tissue.

The hemorrhages are graded from 1 to 4 according to the severity of the bleeding. Small amounts of bleeding (grades 1 to 2) do not usually cause any long-term damage. Larger amounts of bleeding (grades 3 to 4) cause long-term problems. Grades 3 and 4 cause blood clots that can block the circulation system for the cerebrospinal fluid. This blockage is called hydrocephalus.

There is no test or examination that can accurately predict what a premature baby will be like as a child or adult. Only time and growth will show whether the brain has been permanently hurt.

Sometimes other parts of the baby's brain may be able to take over the function of any damaged areas. This means that babies often do much better than expected. They do much better than an adult with a similar brain injury. Love, care, and encouragement, which the child receives from his family, also may have a very important effect on his outcome.

In general, babies who have had small amounts of bleeding (grades 1 and 2) do not have any more problems than other premature who did not have IVH. Babies who have had more severe bleeding are more likely to have developmental problems as they grow. Many children who have had a grade 4 hemorrhage may have problems controlling movement on the side of their body opposite that of the injured part of the brain. If the other side of the brain is normal, these children can often function well enough to attend regular school. Only time will tell to what extent a child's brain is injured and what long-term problems he will have.

When they did Ronan's initial cranial ultrasound scan, they found a grade 1 bleed on one side and a grade 4 bleed on the other. Needless to say, we were very upset after the doctor explained the implications of the bleeds.

After waiting a week, they did a follow-up cranial ultrasound to see if the bleeding had gotten worse. Upon closer examination of the ultrasound, his doctors saw that Ronan had a grade 1 bleed on one side and a grade 2 bleed on the other. The difference between a grade 2 and a grade 4 bleed is tremendous in its long-term implications. In addition, the bleeding did not appear to have gotten any worse on the second ultrasound. This was one of the better pieces of news we received about Ronan since he arrived. They would do a final ultrasound before Ronan left the hospital.

Nicole Zimmerman is the co- author of The NICU Rollercoaster, the touching true story of the early arrival of premature twins and the ups and downs of their 160 days in the hospital. Heart-warming personal preemie blog posts are interspersed with helpful information for preemie parents coping with the issues of very early or small preemies.

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