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Causes of Intracranial Hemorrhages

An intracranial hemorrhage in newborns is defined as the accumulation of excessive amounts of blood in the cranial cavity. Depending on the place where the hemorrhage has occurred, the condition can be categorized as one of the following:

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Children may experience mood swings, anxiety, depression, or restlessness. They may not be very motivated and have a hard time controlling their emotions. Other symptoms of neurological deficiency include denial, self-centeredness, and a low self-esteem.

  • Epidural hemorrhage: accumulation of blood outside the dura
  • Subdural hemorrhage: blood accumulating between the arachnoid matter and the dura
  • Subarachnoid hemorrhage: blood that accumulates between the arachnoid matter and the pia matter
  • Intraventricular hemorrhage: the pathological bleeding inside the ventricles
  • Intraparenchymal hemorrhage: blood accumulating within the brain itself

Needless to say, each kind of bleeding has a specific cause. Let’s take a look at some of the most common reasons for the accumulation of blood in the intracranial vault in newborns.

Main Causes of Intracranial Hemorrhage in Newborns

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One of the most common causes of abnormal bleeding in newborns is preterm delivery. Babies born more than ten weeks before the mother’s term are at an increased risk of bleeding. A detailed overview was presented in the Pediatric Research journal in 2010. According to the authors, nearly 12,000 premature babies develop an intraventricular hemorrhage every single year.

The smaller a baby is at birth and the earlier it is born, the higher the risk of intracranial hemorrhage becomes.

Intracranial hemorrhage will develop much less frequently in full-term babies. The condition typically manifests itself in the first few days of the baby’s life. Babies are unlikely to develop an intracranial hemorrhage after the age of one month, even if they were premature.

Lately, there has been an increase in the number of full-term babies that have been diagnosed with an intracranial hemorrhage. According to medics, the cause isn’t an increase in the number of cases. Rather, imaging and diagnostic technologies have improved, enabling medics to better identify such problems shortly after birth.

A few other reasons/conditions may contribute to an intracranial hemorrhage. These include:

  • Blood pressure problems
  • Respiratory distress syndrome
  • The use of birth-assisting tools (a study presented in the New England Journal of Medicine suggests that intracranial hemorrhages are more common in babies delivered via forceps, c-section or vacuum extraction)
  • Trauma or injury (for example, the baby being dropped shortly after the birth)

The head and the skull of newborns are fragile. Neonatal specialists are aware of the fact, which is why they handle babies with extra caution. Still, accidents may occur in the maternity ward. Complications during the birth itself and the need to assist the mother medicinally during the delivery could also increase the risk of bleeding.

Main Symptoms of Intracranial Hemorrhages

A few symptoms are quite indicative of a bleeding problem in the brain. Medics are aware of these symptoms, and they’ll be particularly observant in the case of preterm babies. Some of the most common intracranial hemorrhage symptoms to be alert of include:

  • Sudden changes in heart rate and blood pressure
  • Lethargy, excessive sleeping and sleep apnea
  • Slow reflexes
  • Poor muscle tone
  • Seizures and abnormal bodily movements
  • A bulging fontanelle
  • Abnormal eye movement
  • Anemia
  • Very high-pitched cries
  • Altered response of the pupil

The symptoms will be dependent on the severity of the intracranial hemorrhage. Four grades are used to determine just how serious the condition is. Here’s a brief overview of the four grades and what each one is characterized by:

  • Grade I: this is brain bleeding that’s confined to the area where it has originated
  • Grade II: bleeding has spread to the area surrounding the original one (inside the ventricles, the blood fills up to 50 percent of the ventricular diameter)
  • Grade III: distension may occur due to the volume of blood that has accumulated in the area
  • Grade IV: bleeding may spread to the brain tissue

The most common grades that pediatricians observe are grades I and II. Usually, these conditions can be resolved without further complications for the newborn. Babies with such a hemorrhage are at a slightly higher risk of suffering from neurological problems later on than babies without a hemorrhage. Thus, medical supervision and prophylactic measures may be required.

Whenever the hemorrhage reaches grade III or IV, however, it can have profound consequences. In some instances, a child may suffer permanent brain damage. A few of the long-term issues linked to such hemorrhages include spastic cerebral palsy, visual problems, epilepsy, developmental delays and motor deficits.

Grade IV is the most severe of them all. If the condition is allowed to progress to this stage, there’s a 90 percent risk of a lethal outcome.

The Diagnostic Process

When parents or doctors notice any of the intracranial hemorrhage symptoms mentioned above, a number of diagnostic tools will be used. The case and the severity of the hemorrhage will be the defining factors for identifying the bleeding early on.

Cranial ultrasonography is one of the primary tools used for the purpose of intracranial hemorrhage diagnosis. Ventricular enlargements, ischemic lesions, and choroid plexus abnormalities can all be identified this way.

Cranial ultrasonography, however, can’t successfully pinpoint smaller hemorrhages. To get better results, imaging experts may rely on CT scans and magnetic resonance imaging (MRI). MRI is best for diagnosing slow- progressing hemorrhages and infratentorial bleeding (located beneath the tentorium of the cerebellum, which makes such bleeding more difficult to see).

All babies born prior to the 30th week of the pregnancy are to have a cranial ultrasonography because of the relatively high risk of a hemorrhage. Such a test can be performed either during the first or the second week of the baby’s life.

Babies that are born between the 30th and the 34th week should have an ultrasound if they exhibit any of the symptoms of an intracranial hemorrhage.

While there is no treatment for intraventricular hemorrhages in newborns, the medical team can undertake measures to stabilize the general condition of the baby. If symptoms appear, these will be treated, as well.