Babies who experience severe brain bleeds during their first year of life are more likely to have long-term visual problems


Severe “brain bleeds” experienced by some babies in the first year following their birth lead to long-term sight problems, researchers at the University of Bristol have found as part of a ten-year follow-up study.

The study, published in the journal Developmental Medicine & Child Neurology today [23 June], reviewed 32 children who had detailed assessments at 10 to 11 years old after experiencing Grades 3 or 4 intraventricular hemorrhage (brain bleeds) and ventricular dilation (IVHVD) as part of a study called DRIFT10.

The DRIFT10 study was set up to investigate a “brain washing” technique for brain bleeds called DRIFT (Drainage, Irrigation and Fibrinolytic Therapy). DRIFT, pioneered by Bristol researchers, is the first and only treatment to objectively benefit infants with serious brain hemorrhage by washing out the ventricles in the brain to remove toxic fluid and reduce pressure.

The research team reviewed 32 children aged 10 to 11 years old. They investigated whether the Grade of IVHVD experienced as babies affected their visual outcome at the end of their primary school years and explored associations between visual outcomes with cognitive outcomes and with extra support at school.

The visual examinations were part of a ten-year follow-up study for children in the original DRIFT randomized trial. Testers followed a protocol, and it was unknown to them whether the child had experienced Grade 3 or Grade 4 IVHVD and all other data.

The study found all 32 children assessed had at least one visual impairment. The average number of impairments per child was six for children who experienced a Grade 4 IVHVD compared to three for children who experienced a Grade 3 IVHVD.

Each extra vision impairment for each child was associated with increased educational support at school, after adjustment for developmental age equivalence.

These sight problems affecting the children ten years later were often due to damage to the visual areas in the brain. These included problems with moving the eyes accurately, with detecting objects in the space around them or with visually matching shapes or orientations of lines.

the 10-year follow up of visual functions in 32 children who in the first year following their birth experienced Grade 3 or Grade 4 Intraventricular haemorrhage with Ventricular dilatation (IVHVD). Credit: University of Bristol

The children’s parents were unaware of these problems and mostly reported their children had normal vision as long as any glasses they had were being worn.

However, the researchers found that for each additional sight problem a child had, they were more likely to be getting extra support with their learning. This suggests the sight problems may have contributed to the difficulties with learning experienced by this group of children.

Cathy Williams, the study’s lead author and Professor of Pediatric Ophthalmology at Bristol Medical School: Population Health Sciences and Consultant Pediatric Ophthalmologist at University Hospitals Bristol and Weston NHS Foundation Trust (UHBW), explained: “Our research suggests that all children who experience brain bleeds or similar problems as babies should have eye tests to identify brain-related vision problems as they grow up, so that appropriate support can be offered to see if it is helpful for them.

“Researchers in the future should be aware that parents who report normal vision may miss sight problems that are important for their children’s learning and development.”

What is intraventricular hemorrhage in babies?

Intraventricular hemorrhage (IVH) is bleeding inside or around the ventricles in the brain. The ventricles are the spaces in the brain that contain the cerebral spinal fluid. Bleeding in the brain can put pressure on the nerve cells and damage them. Severe damage to cells can lead to brain injury.

IVH is most common in premature babies. There are 4 grades of IVH, depending on the amount of bleeding. They are:

  • Grade 1. Bleeding occurs just in a small area of the ventricles.
  • Grade 2. Bleeding also occurs inside the ventricles.
  • Grade 3. Ventricles are enlarged by the blood.
  • Grade 4. Bleeding occurs in the brain tissues around the ventricles.

Grades 1 and 2 are most common. Often the baby has no other complications. Grades 3 and 4 are the most serious. They may result in long-term brain injury to the baby.

What causes intraventricular hemorrhage in a baby?

It is not clear why IVH occurs. Bleeding can occur because blood vessels in a premature baby’s brain are very fragile and break easily. Nearly all IVH occurs within the first few days of life.

Which babies are at risk for intraventricular hemorrhage?

Certain babies are more likely to have IVH. They include:

  • Premature babies
  • Very-low-birth-weight babies (weighing less than 3 pounds, 5 ounces)
  • Babies with breathing problems, such as hyaline membrane disease
  • Babies who have other complications of being premature
  • Labor and delivery problems
  • Genetic background
  • Shaken baby
  • Head Injury
  • Infection in the mother
  • High blood pressure in the mother
  • Blood-clotting problems

What are the symptoms of intraventricular hemorrhage in a baby?

The following are the most common symptoms of IVH:

  • Pauses in breathing (apnea)
  • Slow heart rate (bradycardia)
  • Pale or blue coloring (cyanosis)
  • Weak suck
  • High-pitched cry
  • Seizures
  • Lethargy, stupor, or coma
  • Swelling or bulging of the soft spots (fontanelles) between the bones of the baby’s head
  • Low red blood cell count (anemia)
  • Decreased reflexes
  • Decreased muscle tone
  • Abnormal eye movement

The symptoms of IVH may look like other health problems. Make sure your baby sees his or her healthcare provider for a diagnosis.

How is intraventricular hemorrhage diagnosed in a baby?

Your baby’s healthcare provider will ask about your child’s health history and do a physical exam. Your baby will also need a head ultrasound. This test uses sound waves to make a picture of internal structures. The provider can see the inside of the baby’s brain through the fontanelles. With the ultrasound, the amount of bleeding can be graded.

How is intraventricular hemorrhage treated in a baby?

There is no specific treatment for IVH, except to treat any other health problems that may make the condition worse. Your baby may also need supportive care, such as fluids and oxygen.

Sometimes your baby may need surgery to stabilize his or her condition. This may involve surgery to place a tube (shunt) into the baby’s skull to drain the fluid. But this surgery is rarely needed in babies because their skulls are very flexible.

What are possible complications of intraventricular hemorrhage in a baby?

Complications are more likely to occur if a baby has grade 3 or 4 IVH. They may include:

  • Development problems
  • Too much cerebral spinal fluid in the brain (hydrocephalus)
  • Long-term brain injury
  • Death

How can I help prevent intraventricular hemorrhage in my baby?

Although care of sick and premature babies has advanced greatly, it is not possible to prevent IVH from occurring. But if you are at risk for early delivery, your healthcare provider may give you corticosteroid medicines. This has been shown to lower the risk for IVH in the baby. These steroids are often given to women between 24 and 34 weeks during pregnancy if they are at risk for early delivery.

Key points about intraventricular hemorrhage in babies

  • IVH is bleeding inside or around the ventricles. The ventricles are the spaces in the brain that contain the cerebral spinal fluid.
  • IVH is most likely to occur in premature babies.
  • It is not clear why IVH occurs.
  • A baby with IVH may have breathing problems and a slow heart rate.
  • A head ultrasound can diagnose the condition.
  • There is no specific treatment for IVH.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

reference link :—pediatrics/i/intraventricular-hemorrhage-in-babies.html

Original Research: Open access.
Vision function in children 10 years after grade 3 or 4 intraventricular haemorrhage with ventricular dilation: A masked prospective study” by Cathy Williams et al. Developmental Medicine & Child Neurology 


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