What types of infant brain bleeds are there? What causes each type?
An intracranial hemorrhage (brain bleed) is a traumatic or hypoxic birth injury characterized by sudden, rapid bleeding within the baby’s skull or brain. Causes and risk factors for brain bleeds vary depending on the type and location of the brain bleed. Throughout this page, we’ll cover the different types of infant brain bleeds and their causes.
Types of Infant Brain Bleeds and Their Causes
Subarachnoid Hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is the second most commonly detected neonatal brain bleed and is caused by rupture of veins in the space or spaces near the skull. Hydrocephalus (fluid in the brain) can develop after a subarachnoid hemorrhage because the bleeding causes too much cerebral spinal fluid (CSF) to build up in the brain’s ventricles, which can cause brain and head swelling. Subarachnoid hemorrhage can also cause oxygen to be cut off in certain parts of the brain, which can cause brain tissue to die.
Subdural Hemorrhage (SDH)
Subdural hemorrhage (SDH) or hematoma, is the most common type of baby brain bleed. SDH occurs when there is rupture of the blood vessels in the area between the surface of the brain and the thin layer of tissue that separates the brain from the skull. Sometimes subdural hemorrhage causes an increase in pressure inside the brain, which can cause:
- An increase in head size
- Apnea (periods of not breathing)
- Bradycardia (slow heart rate) &
- Coma
Intraventricular Hemorrhage (IVH)
The brain has four ventricles in the middle of it. Intraventricular hemorrhage is a type of brain bleed characterized by bleeding inside the brain’s ventricles. Intraventricular hemorrhage is most common in preterm babies, although term babies can have IVH as well. Premature babies are more susceptible to intraventricular hemorrhage because blood vessels and other parts of their brains are fragile.
Signs and symptoms of IVH include the following:
- Irritability
- Neonatal seizures
- Apnea
- Bulging fontanelle (soft spot)
Intraventricular hemorrhage can be caused by the same factors that cause subarachnoid hemorrhage and subdural hemorrhage. IVH can also be caused by oxygen deprivation in the baby’s brain, which is a dangerous condition known as hypoxia.
Hydrocephalus
The most common cause of hydrocephalus is a germinal matrix hemorrhage (GMH). GMH occurs primarily in premature infants. This is because activity in the germinal matrix peaks at 8-23 weeks of gestation. The germinal matrix helps create the fully-formed brain; cells develop and leave this structure during brain development. Damage to the germinal matrix at weeks 8-23 can cause severe brain damage and death.
A GMH occurs when there is bleeding into the part of the germinal matrix that is connected to the ventricles. When this occurs, there may be subsequent rupture into the ventricles. A GMH causes the ventricles to be filled with blood and cellular products, and this, among other things, causes dilation of the ventricles. GMH leads to a lot of stress on the areas around it, as well as congestion of the blood vessels. All of these factors can cause injury to the very important white matter in the brain.
Subgaleal Hemorrhage
A subgaleal hemorrhage is a potentially deadly type of brain bleed. Subgaleal hemorrhages are strongly associated with:
- Birth trauma
- Delivery using forceps and
- Delivery using vacuum extractors
Vacuum extraction is the greatest risk factor for a subgaleal hemorrhage. A subgaleal hemorrhage is caused by rupture of veins that are very close to the scalp. When these veins rupture, blood builds up just beneath the scalp, and the baby will have swelling of the head and evidence of shock, which is characterized by severely low blood volume and blood pressure. Prompt and aggressive treatment is critical when this occurs.
Treatment includes administration of blood products to help increase blood pressure. The sooner treatment occurs, the better the outcome for the baby. Subgaleal hemorrhages can lead to epilepsy, cerebral palsy, severe hearing problems, and death.
Cephalohematoma (Cephalhematoma)
A cephalohematoma (or cephalhematoma) is a brain bleed in which blood collects between the skull and its covering as the result of ruptured vessels. Cephalohematoma is caused by any type of trauma to the baby’s head, but it is most commonly associated with forceps and vacuum extraction delivery. The swelling does not cross suture lines, which are bands of tissue that connect the bones of the skull. Discoloration may or may not be present, and there typically isn’t significant blood loss. If a cephalohematoma is left unresolved, it can cause:
- Calcification of the hematoma
- Cony swelling that can last for months
- Skull deformities in the baby, which often require surgery
- Severe infection in the baby
- Death of parts of the baby’s skull
Legal Help for Infant Brain Bleeds
Medical professionals are held to high standards when caring for mothers and their babies during pregnancy, labor & delivery. Any medical error or deviation from medical care standards is considered medical negligence. If your baby suffered a brain bleed, we encourage you to reach out to our birth trauma team for a free legal consultation. ABC Law Centers: Birth Injury Lawyers is one of the only firms in the country that exclusively handles birth injury cases. Every day, our birth trauma attorneys help families like yours secure the resources they need to live lives of rehabilitation, well-being, and equal opportunity.