When a newborn experiences bleeding within the skull during or shortly after birth, it can be an overwhelming and frightening experience for families. Intracranial hemorrhage in newborns, while relatively uncommon, is one of the more serious complications that can occur during delivery. Understanding what it is, how it happens, and what can be done about it helps parents make sense of their child’s diagnosis and navigate the medical care ahead.

This page explains intracranial hemorrhage in clear terms, describes the types and causes, and outlines what families should know about treatment, recovery, and the potential for long-term effects. Whether your child has just been diagnosed or you are trying to understand what happened during delivery, this resource is here to support you with accurate, compassionate information.

What Is Intracranial Hemorrhage?

Intracranial hemorrhage, often abbreviated as ICH, refers to bleeding that occurs inside the skull. In newborns, this bleeding can happen in different areas around or within the brain. The types are usually classified by where the bleeding occurs, and each type has its own set of causes and outcomes.

The skull contains several protective layers and fluid-filled spaces around the brain. When blood vessels rupture or tear during birth, blood can collect in these spaces or within the brain tissue itself. In some cases, the bleeding is minor and resolves on its own without causing harm. In other cases, it can be more significant and require close monitoring or medical intervention.

Intracranial hemorrhage in newborns is most often related to the physical stresses of labor and delivery, particularly in cases involving difficult births, the use of delivery instruments, or babies born prematurely with fragile blood vessels. Understanding the specific type and cause of bleeding helps doctors determine the best course of care and what to watch for as your baby grows.

Why Intracranial Hemorrhage Happens

There are a number of reasons a newborn might develop bleeding in or around the brain. Some are related to the mechanics of birth, while others are linked to the baby’s health or developmental stage.

Birth trauma is one of the leading causes. Prolonged or difficult labor, the use of forceps or vacuum extraction, and breech deliveries can all place mechanical stress on a baby’s head and the delicate blood vessels inside. Instrumental deliveries, in particular, carry a significantly higher risk. Studies have shown that forceps or vacuum-assisted births can increase the likelihood of intracranial hemorrhage by as much as ten times compared to unassisted vaginal deliveries.

Prematurity and low birth weight are also major risk factors. Premature babies have blood vessels that are not yet fully developed, especially in a region of the brain called the germinal matrix. These vessels are extremely fragile and can rupture easily, even without trauma.

Other contributing factors include:

Clotting disorders, such as vitamin K deficiency, which can impair the blood’s ability to clot properly
Maternal health conditions like high blood pressure, which can affect the baby’s vascular system
Rapid changes in blood pressure or oxygen levels during or after delivery
Underlying vascular malformations, though these are rare

Each baby’s situation is unique, and sometimes intracranial hemorrhage occurs even when all standard precautions are taken. Medical teams work to identify the cause in order to provide the most appropriate care and reduce the risk of further complications.

Types of Intracranial Hemorrhage in Newborns

Not all intracranial hemorrhages are the same. The location and extent of bleeding help doctors understand what happened, what the risks are, and how to respond.

Subdural Hemorrhage

This is the most common type of intracranial hemorrhage in full-term newborns. It occurs when blood collects between the tough outer membrane covering the brain (the dura) and the brain itself. Subdural hemorrhage is usually caused by the stretching or tearing of small bridging veins during delivery, especially when there is significant mechanical force involved. Babies delivered with forceps or vacuum assistance, or those who experienced a particularly difficult passage through the birth canal, are at higher risk.

Most subdural hemorrhages are small and do not cause symptoms, but larger bleeds can lead to seizures, irritability, or neurological changes.

Subarachnoid Hemorrhage

This type involves bleeding into the subarachnoid space, the area between the brain and the thin tissues that cover it. Subarachnoid hemorrhage is often mild and may not cause obvious symptoms. It can result from the rupture of small veins during delivery and is more common in babies delivered with instruments or those born prematurely.

Because symptoms can be subtle or absent, subarachnoid hemorrhage is sometimes only detected through imaging done for other reasons.

Intraventricular Hemorrhage

Intraventricular hemorrhage, or IVH, is bleeding that occurs in the fluid-filled spaces (ventricles) inside the brain. It is most common in premature infants because the blood vessels in the germinal matrix, a region near the ventricles, are especially fragile before full term. However, IVH can also occur in full-term babies as a result of birth trauma.

IVH is graded by severity, from mild (grade I) to severe (grade IV), with higher grades indicating more extensive bleeding and greater risk of complications. Severe IVH can lead to hydrocephalus, a buildup of fluid in the brain, and damage to the white matter, which is critical for brain communication and development. These complications significantly increase the risk of cerebral palsy and developmental delays.

Epidural Hemorrhage

Epidural hemorrhage is rare in newborns. It involves bleeding between the skull and the outermost layer covering the brain. This type is usually associated with skull fractures caused by significant trauma during delivery.

Parenchymal Hemorrhage

This refers to bleeding directly into the brain tissue itself. It is less common but can occur with severe trauma or in babies with underlying vascular abnormalities. Parenchymal hemorrhage carries a higher risk of lasting neurological damage.

Recognizing the Signs

Intracranial hemorrhage does not always cause immediate or obvious symptoms. Some babies appear completely normal at birth, and the bleeding is only discovered through imaging ordered because of subtle concerns or routine screening in high-risk cases.

When symptoms do occur, they may include:

Lethargy or decreased activity
Seizures or abnormal movements
Weak or absent reflexes
Irregular or erratic breathing
A bulging fontanelle, the soft spot on top of the baby’s head
Poor feeding or difficulty sucking
Unexplained anemia or pallor

Any of these signs should prompt immediate medical evaluation. Newborns showing neurological symptoms after a difficult delivery or those born prematurely are often screened with imaging studies such as ultrasound, MRI, or CT scan to look for evidence of bleeding.

Early detection is important because it allows doctors to monitor the baby closely, manage complications, and begin interventions that may reduce the risk of long-term harm.

Connection to Cerebral Palsy

One of the most significant concerns with intracranial hemorrhage in newborns is the potential for lasting brain injury. When bleeding damages critical areas of the developing brain, it can lead to cerebral palsy and other neurodevelopmental disabilities.

Severe intraventricular hemorrhage is particularly concerning. Bleeding into the ventricles can injure the white matter, the tissue responsible for transmitting signals between different parts of the brain. White matter damage is a well-established cause of cerebral palsy, especially the spastic forms that affect muscle tone and movement. If IVH leads to hydrocephalus, the increased pressure can cause further injury.

Subdural and parenchymal hemorrhages can also result in cerebral palsy, depending on the location and extent of the bleed. When bleeding occurs in areas that control motor function, the risk of permanent movement disorders increases.

Research consistently shows that babies with significant intracranial hemorrhage, especially when combined with other complications like oxygen deprivation, are at higher risk for cerebral palsy. Large cohort studies and imaging research have documented this link, showing that early brain injury from hemorrhage can result in motor impairments, developmental delays, and cognitive challenges that become apparent as the child grows.

Not every baby with intracranial hemorrhage will develop cerebral palsy. Many factors influence outcomes, including the size and location of the bleed, the timeliness of medical care, and the presence of other injuries. Close follow-up and early intervention are essential for identifying problems early and maximizing each child’s potential.

How Intracranial Hemorrhage Is Managed

The treatment and management of intracranial hemorrhage depend on the severity of the bleeding, the baby’s overall health, and whether complications develop.

Immediate Care

When intracranial hemorrhage is suspected or confirmed, the baby is typically monitored closely in a neonatal intensive care unit. Medical teams watch for changes in neurological status, breathing, and vital signs. Imaging studies, often starting with cranial ultrasound in premature infants, help doctors assess the extent of bleeding and track whether it is worsening or resolving.

Supportive care is the foundation of treatment. This includes maintaining stable blood pressure and oxygen levels, managing any seizures with medication, and addressing complications like anemia or clotting problems. Vitamin K is routinely given to newborns shortly after birth to help prevent bleeding disorders, and additional doses may be provided if a clotting issue is identified.

Neurosurgical Intervention

In cases of large hemorrhages or when fluid buildup causes dangerous pressure on the brain, neurosurgical procedures may be necessary. This can include draining blood collections or placing a shunt to relieve hydrocephalus. These interventions are not always needed, but when they are, they can be lifesaving and help prevent further brain damage.

Long-Term Follow-Up

Even after the acute phase has passed, babies who experienced intracranial hemorrhage need ongoing monitoring. Neurodevelopmental follow-up programs, available at major medical centers like Mount Sinai, Columbia, and NYU Langone in New York, specialize in tracking the development of at-risk infants. These programs provide assessments, early intervention referrals, and therapy services that can make a significant difference in outcomes.

Physical therapy, occupational therapy, and speech therapy are often started early if delays or motor problems are identified. Early intervention has been shown to improve functional outcomes, helping children reach their full potential despite early brain injury.

Preventing Intracranial Hemorrhage

While not all cases of intracranial hemorrhage can be prevented, many risk factors can be managed with high-quality perinatal care.

Careful monitoring during labor and delivery is essential. Recognizing when labor is prolonged or complicated and making timely decisions about the use of instruments or a cesarean delivery can reduce the risk of trauma. Avoiding unnecessary or overly forceful use of forceps or vacuum extractors is part of good obstetric practice.

For premature infants, preventing early delivery when possible and providing appropriate neonatal care after birth are critical. Advances in the care of preterm babies, including medications to stabilize blood vessels and careful management of blood pressure, have helped reduce the incidence and severity of intraventricular hemorrhage.

Routine vitamin K administration at birth is a simple and effective measure that prevents bleeding disorders in newborns. Ensuring that all babies receive this standard care is an important preventive step.

When risk factors are identified, such as maternal hypertension or a history of difficult deliveries, added vigilance and planning can help minimize the chances of complications.

What the Research Shows

Recent medical research has provided a clearer picture of how common intracranial hemorrhage is and what it means for affected babies.

Imaging studies using MRI have found that a significant number of newborns, particularly those delivered vaginally with instrument assistance, may have some degree of intracranial hemorrhage. One study found that up to 33% of newborns delivered with forceps or vacuum showed evidence of bleeding on MRI, though most of these cases were small and did not cause symptoms or lasting problems. Clinically significant hemorrhages, the kind that require treatment or lead to complications, are much less common.

For premature infants, intraventricular hemorrhage remains a leading cause of acquired cerebral palsy. Large cohort studies have documented that the risk of cerebral palsy increases with the severity of IVH and the presence of complications like hydrocephalus or white matter injury.

The good news is that outcomes are improving. Advances in neonatal care, better imaging techniques, and early therapeutic interventions are helping more babies recover without lasting effects. Research continues to focus on understanding which babies are most at risk and how to prevent or minimize brain injury when hemorrhage occurs.

Finding Support and Information

Learning that your baby has experienced intracranial hemorrhage can be overwhelming. You may have questions about what caused it, what will happen next, and what the future holds. It is normal to feel worried, confused, or even angry.

Having access to clear, accurate information can help. NYBirthInjury.com exists to provide families with trusted resources that explain medical conditions, treatment options, and available support. Whether you are trying to understand a diagnosis, find a specialist, or connect with others who have been through something similar, reliable information makes a difference.

Your child’s medical team is your most important resource. Do not hesitate to ask questions, request explanations in plain language, or seek a second opinion if you need more clarity. Neonatologists, pediatric neurologists, and developmental specialists can all play a role in your child’s care and recovery.

If your child develops lasting challenges as a result of intracranial hemorrhage, early intervention programs and therapy services can provide meaningful support. These programs are designed to help children develop skills, overcome obstacles, and reach their full potential.

Moving Forward

Intracranial hemorrhage in a newborn is a serious and often unexpected event, but it does not define your child’s entire future. Many babies recover fully, and even those who face challenges can make remarkable progress with the right care and support.

Understanding what happened, why it happened, and what can be done helps you be an informed advocate for your child. It also helps you know what to watch for and when to seek additional help.

You are not alone in this. Medical professionals, therapists, and other families who have been through similar experiences can offer guidance, hope, and practical support. Taking things one step at a time, staying connected to your care team, and focusing on what your child needs right now are the best ways to move forward.

Intracranial Hemorrhage