Introduction
Premature babies are born early, before attaining the intended growth and development. Thirty-seven weeks is estimated to be the complete duration of a pregnancy that is essential for the baby to establish the necessary growth and development before birth.
Sometimes, the baby gets delivered before the estimated delivery date due to certain underlying maternal reasons or extrinsic factors. Such babies are premature and lack the necessary growth of a newborn baby. Premature babies are born mostly after 27 weeks of pregnancy instead of 37 weeks.
Early-born babies are more vulnerable to numerous health issues than full-term newborns. Incomplete growth and susceptibility to infection make the survivability of premature babies challenging and at risk. However, with technological advancement, the death rate associated with premature babies has decreased drastically over the decade.
What Is Meant by Intraventricular Hemorrhage in Premature Infants?
The human brain encloses spaces that are typically packed with fluid called cerebrospinal fluid. Such enclosed spaces in the brain are medically known by the name ventricles. Four ventricles exist inside the skull and communicate with each other, forming a ventricular system. Normally, this ventricular fluid does not contain any blood cells.
In intraventricular hemorrhage, as the name implies, there will be obvious bleeding into the enclosed spaces, so-called ventricles. It is a grave condition that entails immediate medical attention. It is encountered in premature babies, as their blood vessels are immature and delicate, which enhances the possibility of a break in the blood vessels concerned with blood supply to the brain cells.
Once the blood vessels elicit a break in their integrity, the blood leaks into the ventricular spaces in the brain, giving rise to intraventricular hemorrhage. Intraventricular hemorrhage is rarely reported in full-term babies, and most often, it manifests in premature babies. The risk for intraventricular hemorrhage is directly proportional to the baby's degree of prematurity. Babies born around 27 weeks of pregnancy are more vulnerable to intraventricular hemorrhage than babies born after 30 weeks.
The blood vessels acquire strength during the final stages of pregnancy. The blood vessels fail to attain the desired growth and strength as the baby is delivered prematurely. Intraventricular hemorrhage is elicited in premature babies within a week of age. A baby with intraventricular hemorrhage presents with transient cessation of breathing, sleepiness, tiredness, altered blood pressure, abnormal heart rate, inability to suck the milk properly, and impaired reflexes.
What Are the Risk Factors Associated With Intraventricular Hemorrhage in Premature Infants?
Certain factors tend to elevate the probability of developing intraventricular hemorrhage in premature babies. Some of the known risk factors include the following:
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Low Birth Weight: When the baby is born prematurely, they are often accompanied by low birth weight, where the baby lacks the normal weight it should possess at birth. Babies with birth weight falling behind five pounds and eight ounces are considered low birth weight babies. Low birth weight makes the baby more susceptible to intraventricular hemorrhage. Early birth and low birth weight are more or less interconnected. Prematurity is a direct indication of inadequate growth and development. As the baby cannot attain complete development, there will be an obvious shortfall in the birth weight.
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Pneumothorax: Premature babies are more likely to develop a medical condition called pneumothorax, where the inspired air partly gets into the potential space bounded across the chest wall and the lung. The over-extension of the alveoli (air sacs in the lung) sometimes tears them apart, releasing the air into this potential space fencing the lung within the chest wall, leading to pneumothorax. Pneumothorax is another important triggering factor for intraventricular hemorrhage.
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Sepsis: Infections are frequently encountered with prematurely born babies. Inadequate development of the immune system is responsible for enhanced susceptibility to infections. An aggravated reaction to an infection called sepsis may also develop in certain babies. Sepsis makes the child vulnerable to intraventricular hemorrhage.
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Asphyxia Resuscitation: Premature babies who manifest asphyxia (lacking oxygen) are often supported with considerably high oxygen flow. Asphyxia resuscitation using a high flow of oxygen can aid in reestablishing the oxygen requirement of the baby’s body. However, certain studies have shown that babies treated with a high oxygen fraction are more vulnerable to intraventricular hemorrhage.
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Invitro Fertilization: More recent studies have concluded that babies born via the in vitro fertilization technique, where the egg (ovum) and sperm union take place outside the female body, are more likely to develop intraventricular hemorrhage than the other babies who are born by natural way. However, there is a need for more pieces of evidence to clear off all the confusion concerning in vitro fertilization as one of the risk factors for intraventricular hemorrhage in early-born babies.
What Medical Interventions Are Advised for Dealing With Intraventricular Hemorrhage in Premature Infants?
Intraventricular hemorrhage in premature babies is an alarming condition with no definite curative therapy. However, there are medical interventions to improve the baby’s condition. Prematurely born babies diagnosed with intraventricular hemorrhage necessitate neonatal intensive care support to sustain their lives. Intraventricular hemorrhage can often pave the way for other health complications like hydrocephalus (fluid gathering in the skull); in such cases, appropriate treatment strategies will be employed to deal with the complications.
A panel of specialist doctors often designs the treatment strategies for intraventricular hemorrhage. If there are critical discrepancies in the baby’s blood count and blood pressure, blood transfusion is advised to get it back within the normal ranges. The outcome of the treatment interventions is often guided by the intensity of the bleeding and the stage of the disease condition. Premature babies with a lower stage of intraventricular hemorrhage can often lead a normal life without obvious manifestations.
Conclusion
Intraventricular hemorrhage in early-born babies is often influenced by several associated risk factors, further exposing the newborn and making them vulnerable to developing this complex medical condition. In cases where the expectant mother is more likely to deliver the baby prematurely before the estimated delivery date, pre-administration of corticosteroids is frequently employed to check the development of intraventricular hemorrhage and preterm birth. Since intraventricular hemorrhage lacks a curative therapy, taking precautionary measures to check its development is better advised. The associated risk factors capable of precipitating intraventricular hemorrhage in a premature child aid in identifying vulnerable expectant women; therefore, added attention and preventive interventions using corticosteroid therapy can be effectively initiated. Rather than developing the condition, it is better to take preventive steps at the right time so the baby can remain safe and lead a healthy life.
