Diseases & Conditions


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Brain haemorrhage in pre-term babies


Premature babies are at risk of brain bleeding Babies born several weeks premature face more than one threat to life in their early days. This is simply because not every part of their body has developed sufficiently to function properly outside the womb. One of these risks is that their poorly developed blood vessels will bleed into the brain. The brain requires an excellent blood supply, meaning that some parts have a large number of tiny blood vessels. Fragile vessels Unfortunately, in some premature babies, these are abnormally fragile. Often added to this is another problem - that sickly pre-term infants are unable to apply the normal ways of regulate the flow of blood to the brain. Tiny changes in blood pressure may be enough to trigger a bleed called an intraventricular haemorrhage (IVH). Hard to spot While neonatal experts know that IVH may happen in premature babies - with the risk increasing the earlier the child has been delivered, it can be difficult to detect. It will normally happen within the first 72 hours after birth - most happen in the first two days. There are often no symptoms of a bleed, although sometimes, the baby may be limp and unresponsive, or have fits. An ultrasound scan is used to make a formal diagnosis, and many premature babies are given this check inside their first week. Fatal cases Bleeding can be dangerous because it deprives brain tissue of the oxygen-carrying blood it needs to stay alive. As might be expected, the likelihood of survival depends primarily on the extent of the bleeding. A small, isolated bleed would be expected to be survived by the vast majority of babies - whereas the highest-graded haemorrhage would be likely to kill all but a few. Small bleeds are commonplace in premature babies - and doctors would expect the majority to resolve themselves. Water on the brain In addition, there is another potentially dangerous complication - hydrocephalus, or "water on the brain". This possibly happens because large clots resulting from the bleeding interfere with the normal movement of cerebrospinal fluid, which begins to gather in inside the cranium. Over time, this can place the brain under great pressure, and cause damage. The only treatment for hydrocephalus is an operation performed by a neurosurgeon to relieve the pressure. Few treatments The most effective strategy for IVH is to prevent premature delivery, and reduce the risk of the bleed happening in the first place. The longer the baby can be safely kept in the womb, the less likely IVH is to occur - particularly at its most severe grades. Advances in neonatal intensive care technologies and techniques have reduced the risk of IVH in recent years, and there are a couple of drugs which, if given to the baby, may slightly reduce the chances of a bleed. However, once a premature baby has been born, and an IVH detected, doctors can do little to directly tackle the problem, and must hope that the bleeding resolves itself. Long term effects Children who survive IVH, particularly severe cases or those which go on develop hydrocephalus, may suffer neurodevelopmental disability as a result. Those who suffer the most mild form the condition have been found to suffer no significant neurodevelopment disabilities - but those with the most severe grades are far more likely to be affected.