Brain hemorrhage in infants types causes and treatment methods

Brain hemorrhage in infants is one of the most serious health problems a newborn can face, as it directly affects the brain and nervous system. This issue can be very alarming for any parent, but understanding its causes, types, and treatment options helps families respond quickly and protect their child from complications. In Dalily Medical, we will discuss the different types of brain hemorrhage in newborns, the main causes behind it, and the latest treatment methods that can save the infant’s life and support healthy development.

What Is Intracranial Hemorrhage in Newborns?
Intracranial hemorrhage in infants is bleeding that occurs inside or around the brain shortly after birth. It can be mild with no obvious symptoms, or severe, affecting the child’s growth and long-term health. Although the idea may sound frightening, doctors are well-trained to detect and manage it quickly to reduce complications.

Causes of Brain Hemorrhage in Newborns
Brain hemorrhage in infants can result from several factors during or after birth, including:

Premature birth: Blood vessels in the brain of premature babies are fragile and more prone to bleeding.
Unstable blood pressure: Any fluctuations in blood pressure can cause blood vessels in the brain to rupture.
Large head size: If the baby’s head is too large compared to the mother’s pelvis, it may put excessive pressure on blood vessels during delivery.
Oxygen deprivation during birth: Reduced oxygen supply to the brain can damage brain tissue and lead to bleeding.
Blood disorders: Conditions like hemophilia or vitamin K deficiency reduce the blood’s ability to clot.

Careful monitoring of newborns is essential, especially for high-risk infants, as early detection increases the chances of prompt treatment and recovery.

Types of Brain Hemorrhage in Infants: What’s the Difference?
Brain hemorrhage in infants is not a single condition; it varies depending on the location of the bleeding in the skull. Each type has different causes and potential effects on the child’s health. Knowing the types helps parents and doctors understand the condition and choose the appropriate treatment.

1️⃣ Intraventricular Hemorrhage (IVH)

Most common in premature infants.
Occurs due to fragile, underdeveloped blood vessels near the brain’s ventricles.
Often linked more to the infant’s immaturity than to birth complications.
Premature babies are closely monitored in neonatal intensive care units for this reason.

2️⃣ Subarachnoid Hemorrhage (SAH)

Occurs between the brain and the arachnoid membrane.
Can appear in both full-term and premature babies.
Sometimes associated with oxygen deprivation during birth or minor head trauma.

3️⃣ Subdural Hemorrhage (SDH)

Happens between the arachnoid membrane and the outer tough layer of the brain (dura mater).
Often caused by birth trauma such as prolonged labor or the use of vacuum or forceps.
More directly linked to mechanical pressure on the baby’s head during delivery.

4️⃣ Intraparenchymal Hemorrhage (IPH)

Occurs within the brain tissue itself.
Less common but more severe, as it directly damages brain cells.
May result from severe trauma, blood clotting problems, or complications from another type of severe hemorrhage like IVH.

✅ Summary: The type, location, and size of the hemorrhage determine the severity of symptoms and treatment plan. Some cases are mild and fully recover, while others may require long-term monitoring.

Why Does Brain Hemorrhage Happen in Newborns?

Brain hemorrhage at birth doesn’t happen to every baby, but certain factors can increase the likelihood. Usually, it’s a combination of factors related to the baby, the birth process, or the mother’s health.

1️⃣ Baby-Related Factors (The Infant):

Prematurity and Low Birth Weight:

The most important risk factor, especially for intraventricular hemorrhage (IVH).
Blood vessels in premature babies are extremely fragile.
Even minor changes in blood pressure or oxygen levels can trigger bleeding.

Fetal Distress During Birth:

Oxygen deprivation due to placental or umbilical cord problems.
Causes changes in blood flow to the brain, increasing the risk of hemorrhage.

Infections:

Infection in the womb or during delivery.
Can affect blood vessels and the clotting system.

Blood Clotting Problems:

Genetic conditions like hemophilia.
Vitamin K deficiency, which is essential for blood clotting.
Increases the risk of bleeding in the brain and other areas.

2️⃣ Birth-Related Risk Factors:

Difficult or Prolonged Labor:

Long or complicated labor exposes the baby’s head to continuous pressure in the birth canal.
This can cause head trauma and increase the risk of bleeding, especially subdural hemorrhage (SDH).

Instrument-Assisted Delivery (Vacuum or Forceps):

Sometimes used if labor doesn’t progress or the baby shows signs of distress.
Although lifesaving, these tools apply direct pressure to the baby’s head, increasing the risk of blood vessel rupture and hemorrhage, particularly SDH and occasionally other types.

Breech Delivery:

If the baby is in a breech position (feet or buttocks first), passage through the birth canal is more difficult.
This can put unusual pressure on the head and increase the risk of bleeding.

Rapid (Precipitous) Labor:

Even very fast labor can be risky; sudden and rapid pressure changes on the head may increase the chance of brain hemorrhage.

3️⃣ Mother-Related Risk Factors:

Infections during pregnancy or labor: Such as chorioamnionitis, which may trigger preterm birth and increase the baby’s risk of hemorrhage.
High blood pressure or preeclampsia: Can affect placental blood flow and fetal growth, increasing the likelihood of preterm delivery.
Use of certain medications: Blood thinners (anticoagulants) may affect the baby’s clotting system.
Severe trauma: Rarely, major injury to the mother may impact the fetus as well.

It’s important to understand that these factors often interact. For example, a premature baby already has fragile blood vessels, and if birth is complicated with instrument use, the cumulative risk becomes much higher. That’s why preterm infants are the most vulnerable group for brain hemorrhage.

Signs and Symptoms: How to Detect Brain Hemorrhage in Your Newborn

Newborns cannot tell you if they are in pain or if something is wrong. Therefore, as a parent, it’s your responsibility to notice any changes in your baby’s behavior or physical condition. The medical team in the neonatal unit or NICU will monitor these signs, but being aware of them can help ensure early intervention.

⚠️ Important Note: Not all of these signs necessarily indicate a brain hemorrhage, but the presence of any of them requires immediate medical evaluation.

Key Warning Signs to Watch For:

Seizures or Convulsions

Rhythmic movements of one limb, repeated blinking, or involuntary sucking and chewing.
Sometimes just staring or lack of response.

Breathing Difficulties or Apnea

Irregular or shallow breathing, or brief pauses in breathing.

Changes in Consciousness and Behavior

Extreme sleepiness or difficulty waking the baby.
Weak, loud, or unusual crying.
Poor feeding or loss of interest in breastfeeding or bottle-feeding.

Muscle Weakness (Hypotonia)

The baby appears floppy and does not hold their body normally when lifted.

Bulging or Tense Fontanelle

The soft spot on the baby’s head becomes swollen or tight to the touch.

Abnormal Eye Movements

Sudden, rapid, or involuntary eye movements, or eyes looking downward.

Paleness or Cyanosis

Skin color changes due to poor blood flow or oxygen deficiency.

Slow Heart Rate (Bradycardia)

May indicate increased intracranial pressure.

Diagnosis: How Is Brain Hemorrhage Detected in Newborns?

When brain hemorrhage is suspected, doctors need to “look inside the head” to confirm the diagnosis, locate the bleeding, and determine its severity. This information guides treatment and helps anticipate potential complications. Fortunately, several advanced imaging techniques are used for this purpose:

1️⃣ Cranial Ultrasound (Via Fontanelle)

Often the first test, especially for premature babies.
Uses the soft spot (anterior fontanelle) as a window to view the brain.
Advantages:
- Completely safe, no radiation.
- Can be done bedside in the NICU.
- Allows regular monitoring to track bleeding progression.

2️⃣ Computed Tomography (CT Scan)

Uses X-rays and computer processing to create detailed cross-sectional images of the brain.
Best for: Emergency situations or acute hemorrhage.
Drawback: Involves ionizing radiation, so it’s used cautiously in infants.

3️⃣ Magnetic Resonance Imaging (MRI)

Provides the most detailed images of brain structures and soft tissues.
Advantages:
- No radiation.
- Shows the hemorrhage and areas of damage caused by oxygen deprivation.
- Helps assess long-term risk.
Drawbacks:
- Takes longer (30–60 minutes).
- The baby must remain still, sometimes requiring light sedation.
- Less available for urgent bedside use compared to ultrasound or CT.

✅ Summary: Diagnosis usually starts with cranial ultrasound for routine monitoring, followed by CT or MRI in selected cases for a more detailed assessment.

Treatment of Brain Hemorrhage in Newborns: Key Approaches

After diagnosing brain hemorrhage, the next crucial question is: how is the baby treated?

There is no “magic cure” that immediately removes the bleed, but important medical steps focus on two main levels:

1️⃣ Supportive Care (Main Treatment)

This is the cornerstone for most cases, especially mild to moderate bleeding.
The goal is to stabilize the baby and support natural brain recovery.

Supportive care includes:

NICU Admission: Continuous monitoring to allow rapid intervention if needed.
Stable Environment: Proper temperature, reduced noise and light, and gentle handling.
Respiratory Support: From simple oxygen to mechanical ventilation if the bleeding affects the brain’s breathing center.
Maintaining Normal Blood Pressure: Monitoring and adjusting blood pressure to ensure stable blood flow to the brain.
Fluids and Nutrition: IV fluids initially, gradually introducing feeding according to the baby’s tolerance.

Seizure Management:

Anticonvulsant medications are used if seizures occur, to protect the brain from further damage.

Close Monitoring:

Continuous tracking of vital signs (heart rate, breathing, temperature, oxygen saturation), head circumference, and repeated neurological assessments.

2️⃣ Imaging Follow-Up

An essential part of treatment is repeated imaging, especially cranial ultrasound.

Brain hemorrhage may not be a one-time event; it can expand or cause later complications.
The most common complication is hydrocephalus – accumulation of cerebrospinal fluid (CSF) in the ventricles, increasing intracranial pressure and affecting the brain.
Early detection through imaging allows doctors to intervene promptly before further damage occurs.

✅ Summary:
Treatment focuses on supporting and closely monitoring the baby, preventing complications, and following the hemorrhage with imaging to provide the best chance for brain recovery.

Specific Treatments for Neonatal Brain Hemorrhage

In some cases, the baby may require more targeted treatments in addition to supportive care:

1️⃣ Hydrocephalus Treatment

If CSF accumulates and increases intracranial pressure, intervention may be necessary to drain it.
Methods include:
- Repeated spinal or ventricular taps: Temporarily reduce fluid.
- Shunt: A tube diverts fluid from the brain to another body cavity, usually the abdomen, for persistent cases.

2️⃣ Neurosurgery

Very rare cases, such as a large hemorrhage causing brain compression or a specific blood clot.
Surgery aims to remove the bleed or reduce pressure and is reserved for complex, severe cases.

Preventive Measures Before and During Pregnancy

Careful Pregnancy Monitoring:

Early detection and management of maternal issues like high blood pressure, gestational diabetes, or infections reduce the risk of preterm birth and brain hemorrhage.

Preventing Preterm Birth Whenever Possible:

Premature infants are at the highest risk of brain hemorrhage.
Efforts include treating infections, controlling early contractions, and avoiding risk factors like smoking.

Antenatal Steroids and Magnesium:

If preterm birth is expected between 24–34 weeks, mothers receive steroid and magnesium injections at least 24–48 hours before delivery.
Benefits:
- Reduce the risk of brain hemorrhage in premature infants.
- Decrease severity if hemorrhage occurs.
- Accelerate fetal lung maturity and strengthen delicate blood vessels in the brain.

Maintaining a Healthy Maternal Lifestyle:

Balanced nutrition, avoiding smoking, alcohol, and drugs.
Managing chronic illnesses.
All these measures improve maternal and fetal health and reduce risks.

Delivery Measures to Reduce the Risk of Brain Hemorrhage in Newborns

1️⃣ Careful and Skilled Labor Management

Having an experienced medical team in the delivery room is essential.
The team can recognize early signs of fetal distress and manage complicated deliveries, such as breech births or preterm deliveries.
Avoiding unnecessary interventions reduces the risk of trauma to the baby.

2️⃣ Careful Assessment Before Using Assisted Delivery Tools

Using instruments like forceps or vacuum increases the risk of hemorrhage. Therefore:
- The decision should only be made when there is a clear medical indication.
- The procedure must be performed by a skilled doctor to minimize risks.
Unjustified or careless use of these tools can lead to serious complications.

3️⃣ Continuous Fetal Monitoring

Fetal monitoring devices track:
- The baby’s heart rate
- Maternal contractions
Early detection of problems allows timely intervention, such as:
- Changing the mother’s position
- Administering oxygen
- Performing a cesarean section if necessary

4️⃣ Presence of a Neonatal Care Team Ready at Delivery

In high-risk deliveries, having a pediatrician or neonatal specialist in the delivery room is crucial.
They can provide immediate care to the newborn, stabilize the baby, and start treatment if required.