Intracranial hemorrhage in newborns. Cerebral hemorrhage: consequences in preterm infants. Causes of intraventricular hemorrhages in newborns

Hemorrhage in the brain is a rupture of pathologically altered walls of cerebral vessels located inside the cranium or in the space between the cranial vault and the dura mater. Pathology most often appears as a result of mistakes by medical personnel made in the process of providing obstetric care during labor, but sometimes the cause of intracranial bleeding may be a complicated course of pregnancy or a woman’s failure to comply with regimen recommendations (for example, the lack of long walks and fetal hypoxia developing against this background ).

The consequences of a cerebral hemorrhage for a newborn can be very dangerous, since it is the rupture of cerebral vessels that leads to cerebral palsy. However, the prognosis can be quite favorable, provided that the problem is detected in time and the correct treatment and care is provided.

Pathological changes in the blood vessels of the brain often develop with a lack of oxygen, so a pregnant woman is advised to spend as much time as possible in the fresh air. In some cases, fetal hypoxia may be the result of metabolic disorders in the body of a woman or child. Pathologies in the formation and functioning of the placenta (for example, premature aging) lead to insufficient supply of oxygen and nutrients, which is a risk factor for the occurrence of intracerebral hemorrhage.

Acute hypoxia can also occur with prolonged and difficult labor. Misdiagnosis of the size and weight of the fetus is a great danger: if the circumference of the baby's head is wider than the mother's birth canal, the baby may get stuck and suffocate. In this case, the doctor decides whether to apply obstetric forceps or use a vacuum. These procedures are also quite dangerous, since with a strong compression of the head, the blood vessels of the brain are squeezed, which can burst under the influence of increased pressure.

Note! Hemorrhage in the brain during the application of obstetric forceps is diagnosed in 42% of babies, therefore, during pregnancy, it is important to undergo examinations prescribed by the doctor on time to exclude complications during labor. With significant risk factors, a woman will be offered to remove the fetus by caesarean section, which will reduce the likelihood of negative consequences.

Other causes of cerebral hemorrhage in newborns include:

• premature, rapid birth;
• childbirth after 40 weeks of gestation;
• maternal infections during pregnancy.

Infectious diseases of the mother during childbearing, such as sexual infections, have a very negative effect on the condition of the fetus and its development. Damage to blood vessels can occur even during fetal growth, so a woman should be attentive to her own body and take all measures to prevent infectious diseases.

Types of bleeding

To determine the prognosis of life and health, it is necessary to correctly classify the type of hemorrhage. Types of pathology differ in location and causes of occurrence, and their diagnosis can give a more complete clinical picture and determine treatment tactics.

Important! The most favorable prognosis is subarachnoid hemorrhage. With timely medical care and proper care, the child's brain will recover in a few months. The most dangerous is hemorrhage in the ventricles of the brain. This type of cerebral bleeding has the highest mortality rate and poor life prognosis.

Possible consequences

The most common complications of cerebral hemorrhage are pathologies of a neurological nature such as paresis. This is a decrease in strength caused by damage to the motor pathway of the nervous system. Simultaneously with paresis, the child may experience involuntary muscle contractions - convulsions. With severe violations, their number can reach up to 15-20 attacks per day. A child with a convulsive syndrome should be under constant medical supervision and be registered in a specialized medical institution. It is not excluded the development of epilepsy - a chronic neurological disorder in which a person is prone to frequent seizures.

Another possible complication is cerebral hydrocephalus. It is a collection of fluid in the ventricles of the brain. At the same time, intracranial pressure rises in the newborn, increased anxiety appears. Such a child does not fall asleep well and wakes up quickly, as he experiences severe headaches due to the constant pressure of fluid on the cerebral hemispheres. The consequences of hydrocephalus can be:

• epileptic disorders;
• cerebral palsy;
• lag in physical and mental development.

Cerebral palsy in a newborn can occur both with damage to several parts of the brain, and with impaired functioning of one lobe. With this disease, the child's motor activity is impaired. In 70% of cases there is a violation of the intellect. Such a child most often cannot move without assistance, does not speak and does not have basic self-care skills.

Changes in behavior

Any form of hemorrhage can affect the behavioral characteristics of a child at an older age. Children who have experienced intracranial bleeding in the first day of life may have difficulty falling asleep. At the age of 1-3 years, such children often wake up at night, some may experience hallucinations. If a child wakes up at night, he cannot fall asleep for a long time, experiences a feeling of anxiety and inexplicable excitement.

The appetite of such children is often reduced, while they do not have an addiction to any particular dish. In the first year of life, parents may face the problem of feeding and introducing complementary foods. To control a child's appetite and provide them with the necessary nutrients, it may be necessary to constantly take multivitamin preparations and mineral supplements, as well as the introduction of specialized formulas for children with developmental delays or poor appetite.

Important! Most children who have had a cerebral hemorrhage suffer from increased excitability, which affects their studies and relationships with peers. Some children (mostly boys) may show aggression towards other children and adults. In such a situation, the child will most likely need the help of a psychologist or psychotherapist.

Cerebral hemorrhage is a dangerous pathology that is almost impossible to protect against, so the expectant mother should be as careful as possible about her own health during pregnancy and undergo all the examinations prescribed by the doctor. During childbirth, it is necessary to listen to the instructions and advice of the midwife in order to avoid complications and the need to use instrumental methods of childbirth.

Video - Hemorrhage in the brain. The threat of cerebral palsy

Premature babies often have various health complications, including brain hemorrhage. They can occur in 50% of cases of children born at 25 weeks, and at 28 weeks the risk is already about 20%.

The brain is covered with three membranes that protect it from various influences. They are penetrated by many blood and lymphatic vessels, they are not in the brain itself. A cerebral hemorrhage occurs when an intracranial vessel ruptures.

About half of hemorrhages appear on the first day of life, after the third day they are unlikely.

Hemorrhage in premature babies of 1-2-3 degrees

There are several systems that determine the extent of brain damage during hemorrhage. One distinguishes 4 degrees of damage, the other, which is considered international - three. Therefore, we describe three degrees:

1. Subependymal. Occurs due to hypoxia (oxygen starvation) of the brain.
2. Intraventricular with filling less than 50%. In this case, the expansion of the ventricle of the brain is not observed.
3. Intraventricular with filling more than 50%. In this case, the expansion of the ventricle is observed.

Separately, paranchymal hemorrhages are described, in which blood penetrates into the substance of the brain.

Causes of cerebral hemorrhage in premature babies

The causes of cerebral hemorrhage in premature babies are the following:

1. Oxygen starvation of the fetus during pregnancy and childbirth. May be due to maternal smoking. And in general, bad habits often lead to the birth of premature babies.
2. The weight of the baby at birth is less than 1.5 kg., It is observed at the birth of children at short gestations. In such children, the cranium is not yet strong enough and the slightest impact can cause a shift in the bones of the skull and rupture of blood vessels.
3. Unskilled actions of personnel during childbirth, especially when applying forceps. After childbirth, the wrong actions of doctors, for example, giving excessive oxygen therapy or administering too large doses of drugs, can also lead to hemorrhage.
4. Too fast births threaten that due to the unavailability of the birth canal, too much squeezing of the baby's head may occur, and prolonged labor threatens with hypoxia.
5. Pathological pregnancy, in which viral intrauterine infections or intrauterine hypoxia are frequent.

Brain hemorrhage: symptoms in children

Depending on where the vessel ruptured, different types of hemorrhages are distinguished, they are accompanied by different symptoms.

1. With epidural bleeding, blood flows between the brain and the cranium. This type of bleeding is characterized by the fact that after a calm period of about 4-6 hours, the baby's condition rapidly worsens, suffocation, convulsions, slow heartbeat are observed, and blood pressure decreases. If you do not help the child in a timely manner, then after two days he may fall into a coma.
2. With subdural bleeding, blood spills between the dura and pia mater. At the same time, convulsions, hemorrhages in the retina of the eye, a rapid increase in the size of the head, crying, turning into a scream are observed. With rapid diagnosis and treatment, the prognosis is favorable.
3. With subarachnoid bleeding, blood penetrates between the brain and the arachnoid. In this case, inflammation of the meninges occurs due to poisoning with blood decay products. At the same time, convulsions and general arousal, sleep disturbance, strabismus, an increase in head circumference, tension of the occipital muscles are observed. The health effects are often minor.
4. With hemorrhages directly into the brain and ventricles, the baby has an inability to swallow and suck, swelling and tension of the fontanelles, convulsions and trembling.

A combination of several types of bleeding is possible, the symptoms can also be combined.

Diagnosis of intracranial hemorrhages in newborns is extremely difficult, therefore, several studies are carried out: computed tomography and electroencephalography of the brain, examination of the fundus, coagulogram (study of blood clotting indicators), laboratory studies of cerebrospinal fluid (cerebrospinal fluid).

Treatment of hemorrhage in a premature baby

Treatment of cerebral hemorrhage in premature babies is to remove the remnants of red blood cells and relieve pressure on the brain. If the diagnosis is made on time and the treatment is carried out in a timely manner, then the results are good, because. the brain of a child is highly plastic and is able to quickly regenerate lost cells. Vitamin K is mandatory. With subdural hematomas, surgical intervention is possible to remove the hematoma.

Cerebral hemorrhage: consequences in premature babies

The consequences of a cerebral hemorrhage usually appear within the first three days after birth. After this period, the risk is significantly reduced. Even if small hematomas have formed, they resolve on their own.

Hemorrhages of 1 and 2 degrees of severity are usually cured without any special consequences. With hemorrhages in newborns of the 3rd degree, the risk of severe neurotic consequences is about 30%. Particularly dangerous parenchymal bleeding, in this case, the risk is 70%.

In 50%, parenchymal bleeding can lead to cerebral palsy or a mental disorder, and the child may also be at risk of hearing or vision loss. It is also possible inflammation of the meninges and the occurrence of dropsy of the brain - hydrocephalus. Therefore, it is important to conduct repeated examinations and monitoring of the treatment of the disease.

In order not to have to worry about this, expectant mothers should carefully check their health before pregnancy and be sure to follow all the doctor's recommendations during pregnancy. Of course, to exclude the possibility of intrauterine infection, undergo examinations for toxoplasma, rubella, and genitourinary infections. And by all means forget about all bad habits, especially about smoking. Only in this case, the risk of having a premature and sick child is significantly reduced. The choice of a maternity hospital should also be approached with all responsibility, because medical errors will hurt the baby's health, which can be undermined for life.

Intraventricular hemorrhage (IVH) is a pathology in which small vessels burst and bleed into the ventricles of the brain of a newborn child.

The ventricles are cavities in the brain that are filled with CSF (cerebrospinal fluid). A person has several of them and they are all interconnected.

The diagnosis of IVH is quite often made in premature babies, due to their physiological characteristics. The shorter the gestational age, the higher the likelihood of hemorrhage.

Hemorrhage does not appear just like that, there must be reasons for this violation.

Who is at risk?

Hemorrhage in the brain of newborns can be associated both with damage to the skull itself, and with a lack of oxygen.

Prerequisites for VZhK:

1. Overdose or, conversely, undermaturity. Premature babies are especially susceptible to intracranial hemorrhages, since their immature vessels do not yet have sufficient support in the tissues. In children born later than the term, the bones are compacted, and the head is not able to be configured during childbirth. According to statistics, IVH occurs in every fifth premature and every tenth post-term baby.
2. The size of the fetal head does not correspond to the size of the birth canal. In this case, natural delivery is contraindicated, because it is fraught with injuries and hypoxia for a newborn child.
3. Difficult pregnancy(fetal hypoxia, intrauterine infection with various infections).
4. Complicated (protracted or rapid) childbirth, breech presentation.
5. Incorrect actions of obstetricians during childbirth.

Based on the above, several risk groups can be distinguished.

The risk of cerebral hemorrhage in a child increases with:

• prematurity;
• low birth weight (less than 1.5 kg);
• lack of oxygen (hypoxia);
• trauma to the child's head during childbirth;
• complications with breathing during childbirth;
• infections leading to bleeding disorders.

If a child belongs to at least one of these groups, it is necessary to find out if he has symptoms of intracranial hemorrhage.

Characteristic symptoms

There are not always visible signs of hemorrhage. Also, if a child has any of the following symptoms, then it is not at all necessary that this is due to IVH, they may be due to other diseases.

The most common symptoms of intraventricular hemorrhage in infants are:

In premature babies, IVH manifests itself with a sharp and rapid deterioration in the condition on the second or third day after birth.

Severity

There are several classifications of hemorrhages, most of them include 4 stages. The following is the gradation most commonly used in modern medicine:

To establish this or that degree of hemorrhage is possible only with the help of a special study.

Diagnostic methods and criteria

For diagnosis in the presence of appropriate symptoms, as a rule, it is used (with the help of sound waves, ruptures of blood vessels and bleeding are determined). Blood tests for anemia, metabolic acidosis, infections are also given.

When diagnosing a pathology of any degree, the specialist selects an individual treatment for the patient.

Possibilities of modern medicine

If a child has a hemorrhage in the ventricles of the brain, then he should be under the watchful supervision of the medical staff. Monitoring of the baby's condition is carried out in order to make sure it is stable.

Basically, therapy for IVH is aimed at eliminating complications and consequences. If any diseases have arisen as a result of hemorrhage, appropriate treatment is prescribed.

Sometimes (if too much fluid accumulates in the brain), the following measures are applied:

1. Ventricular(through the fontanel) or (through the lower back) puncture.
2. when a special drainage tube is inserted into the ventricles. It extends under the skin to the patient's abdomen, where excess CSF is absorbed. The drainage system must be constantly in the body, and the tube is replaced if necessary.

It should be noted that for the majority of patients (with IVH grades 1 and 2), no therapy is required at all, and a favorable outcome can be expected.

Caution, operation video! Click to open

Prognosis depending on the degree of hemorrhage

The consequences will depend on the degree of IVH and the adequacy of the actions of the medical staff:

Preventive measures

One hundred percent hemorrhage in the brain of the baby cannot be prevented, but some measures can and should be taken to reduce the risk.

Correct definition of tactics of delivery

Often, perinatal intracranial hemorrhages occur due to birth trauma, so it is extremely important to carefully evaluate the ratio of the pelvis of the woman in labor and the fetal head.

If there is a discrepancy, natural childbirth is contraindicated, a caesarean section is prescribed. This operation is also performed in diseases associated with a decrease in platelets in the blood of a pregnant woman or fetus (poor clotting).

In addition, in this case, special therapy is prescribed (corticosteroids, immunoglobulin, platelet mass). During childbirth, it is important to monitor the blood pressure of the child, it is necessary to avoid its fluctuations so that cerebral blood flow does not increase.

Prenatal screening

Although these studies are not mandatory for a pregnant woman, they should not be ignored.

In addition, you should be aware that intracranial hemorrhages are possible not only in newborns. They can occur due to trauma at absolutely any age.

Damage to the central nervous system occupies a leading position among the mortality of newborns. One of the most common ailments is cerebral hemorrhage in newborns. There are cerebellar, intra- and periventricular, parenchymal, epidural and subarachnoid hemorrhages. The seriousness of the problem lies in the high probability of death and severe disability in young patients.

Cerebral hemorrhage is more common among preterm infants

The frequency of intraventricular and paraventricular cerebral hemorrhages in newborn full-term babies is no more than 10%, while among premature babies weighing less than 1.5 kg, the frequency of such cases reaches 30–35%, and almost 100% in children weighing 1 kg and less. The frequency of cases of other types of hemorrhages is very variable and does not matter much, because the leading cause of death in newborns is precisely hemorrhages in the ventricles of the brain.

It turns out that when conducting a preventive mass ultrasound of the brain in apparently healthy full-term children, mild intraventricular hemorrhages are detected in 2-3%, which do not have any clinic.

Risk factors

A complex of several reasons undoubtedly leads to cerebral hemorrhage, we list the main, most significant risk factors:

• birth injury;
• congenital oxygen deficiency, which has serious consequences in the form of a decrease in blood pressure, metabolic disorders;

Due to impaired perfusion in the placenta, the fetus receives oxygen-poor blood

• congenital conditions associated with impaired blood clotting (vitamin K deficiency, increased bleeding due to impaired platelet function);
• in premature babies, this is a violation of the automatic regulation of the blood flow of the brain, which arose after suffering suffocation simultaneously with oxygen deficiency;
• the transferred intrauterine infections have a devastating effect on the vessels and the brain;
• low body temperature;
• reduced amount of glucose in the blood;
• heart failure;
• open ductus arteriosus;
• high risk of cerebral hemorrhages in premature babies, babies with low body weight;

Premature newborn in an incubator

• medical reasons: harsh values ​​of artificial respiration, rapid infusion of solutions into a vein, uncontrolled oxygen therapy, painful procedures, careless child care, traumatic procedures, incorrect drug prescriptions;
• social reasons: a poor prognosis exists in children born in dysfunctional families, if the mother suffers from drug addiction or alcoholism, smoked during pregnancy, is a carrier of sexually transmitted infections.

The immediate causes of birth trauma are the discrepancy between the baby's head and the size of the mother's pelvis, which happens at the birth of large children and abnormalities of the pelvic bones in the mother. The cause of injury can be fast (2 hours) or slow (12 hours) childbirth, improper placement of obstetric forceps on the baby's head, pulling the baby by the head, the use of vacuum if the baby is born legs first. The ratio of traumatic and non-traumatic cerebral hemorrhage is 1:10.

Development mechanisms

Hemorrhages under the dura mater and in the region of the cerebellum appear as a result of a birth injury - with cracks and fractures of the bones of the cranial vault, blood vessels rupture and bleeding opens. Simultaneously with sub- and epidural hemorrhages in children, bruises (cephalohematoma), clavicle fractures, traces of forceps or a vacuum extractor can be seen on the head.

Periventricular and intraventricular cerebral hemorrhages in newborns develop as a result of oxygen deficiency, which can be observed with arterial hypertension, ischemia and venous congestion of the brain, with thrombosis, and blood clotting disorders.

Subarachnoid hemorrhage can occur spontaneously, either as a result of trauma or as a result of oxygen deficiency.

The result - injuries lead to superficial hemorrhages, but dangerous hemorrhages in the depths of the brain are the outcome of hypoxia.

Symptoms

The most common manifestation of intracranial hemorrhage in newborns is a sharp deterioration in well-being, with the development of dyspnea attacks, outbreaks of hyperexcitability.

As well as:

• There is a change in the cry, it can be weak or very intense.

In a newborn, an intracranial hematoma may be manifested by anxiety and a change in crying.

• There is bulging and tension of the large fontanel.
• Eye symptoms are noted: rolling the eyes to the lower eyelid, chaotic movement, strabismus.
• Body temperature can either jump or become extremely low.
• Digestive disorders: regurgitation, vomiting, bloating, unstable stools, which leads to poor weight gain.
• Rapid breathing and pulse may be noted, while the hands may remain cold.
• Trembling of the limbs, a sharp start, convulsions.
• Muscle tone disorders.
• increase in anemia.
• Metabolic disorders, which are reflected in the biochemical blood test.

The listed symptoms vary greatly depending on whether the child is full-term or not, how large the hemorrhage is, where it is located. The condition of the child is aggravated by the addition of pneumonia, heart failure, meningitis, a systemic inflammatory reaction, and adrenal insufficiency.

Varieties of brain hematomas

epidural hemorrhages

They are located between the dura mater and the superficial bones of the skull. Distinguished by the absence of a sequence of symptoms. After imaginary well-being (up to 6 hours), the child becomes restless, progressive compression of the brain develops - after 1–1.5 days, coma is likely to develop. Classic symptoms: dilated pupils, convulsions, immobility of the arm and leg on one side, suffocation, low blood pressure and a slow pulse.

subdural hemorrhages

It is observed when the bone plates of the skull are displaced. It is the result of applying forceps to the baby's head, the birth of a child with legs forward, therefore it is rare and mainly in large newborns. Localization - the region of the back of the head, the crown. Symptoms of the disease develop slowly: 1-3 weeks after birth.

Hemorrhage in the cerebellum

It proceeds severely with pronounced symptoms of depression of the central nervous system, compression of the brain stem. The course depends on the timeliness of diagnosis and treatment - with early diagnosis, more than half of the children have a chance for a favorable outcome.

The cerebellum is responsible for coordinating movements

Subarachnoid hemorrhages

Occurs when meningeal vessels rupture. Symptoms of the disease develop immediately after birth, but may take several days. Light hemorrhage can proceed unnoticed, moderate and severe occur with the manifestation of meningeal symptoms, intracranial hypertension, hydrocephalus.

Intraventricular hemorrhages

Symptoms have a wave-like, spasmodic course, which are subsequently replaced by deterioration or improvement in well-being. More or less voluminous hemorrhage into the ventricles of the brain is manifested on the second day of life by anemia, bulging of the fontanel, decreased muscle tone, physical activity, the child stops eating, shortness of breath increases, abnormal eye movements are noted, a drop in blood pressure, frequent pulse.

Effects

If the hemorrhage is asymptomatic, or neurological disorders are minor, then the further prognosis is quite favorable. If the hemorrhage is extensive and was not detected in the first days after childbirth, then a cyst will form in the future, since the brain tissue inside the hemorrhage is destroyed, this can be the cause of all kinds of neurological disorders in the child, mental and physical development retardation.

The prognosis depends on the timeliness of diagnosis, treatment, localization and size of the hemorrhage.

In 50% of even treated children, the ventricles subsequently dilate, which leads to the development of dropsy of the brain (hydrocephalus). Complications such as ventriculitis, cerebral palsy, meningoencephalitis, CSF circulation disorders can significantly reduce the life expectancy of young patients.

Diagnostics

If an intracerebral hemorrhage is suspected, a child in the maternity hospital undergoes an ultrasound examination of the brain in standard head planes, through a large fontanel. In more obscure cases, CT may help confirm the diagnosis.

Treatment

Newborn children with cerebral hemorrhages are under strict medical supervision in a protective regime. Child care is carried out gently and carefully, any procedures are performed as carefully as possible so as not to cause pain and discomfort to the child.

Children are fed through a bottle, sucking milk from the breast is unsafe due to physical activity, children in serious condition are fed through a tube and droppers.

Treatment is carried out according to the main symptoms:

• To stop bleeding, Etamzilat, Vikasol are introduced.
• For convulsions - Phenobarbital.
• With cerebral edema - Diakarb, Mannitol.
• According to the indications, nootropics, antibiotics, vascular drugs, electrolytes are prescribed.

With increasing hemorrhage, massive process with displacement of the ventricles and other brain structures, neurosurgical treatment is performed; 30-40% of children need it. Surgical methods include lumbar and ventricular punctures, suction of blood from the foci of hemorrhage, and installation of liquor shunting tubes. A third of patients recover after surgical treatment.

If necessary, treatment of intracranial hematomas is carried out surgically.

The appearance of a child in the family is associated with new, previously unknown difficulties, which can sometimes be completely unpredictable and even dangerous. The reasons for this are different, the outcome is not always favorable. However, the sooner the disease is diagnosed, the sooner its treatment begins, the more likely the baby is to be healthy and happy.

Traumatic brain injury often occurs in the perinatal period and is manifested by dysfunction of vital organs and systems. A cerebral hemorrhage occurs, which can cause serious harm to the health of your baby.

What causes cerebral hemorrhage in newborns

Intracranial hemorrhages are hypoxic lesions of the central nervous system. The causes of chronic oxygen deficiency are:

• severe pregnancy;
• violation of uteroplacental circulation;
• premature detachment of a normally located placenta;
• bleeding;
• inconsistency of the fetal head with the size of the birth canal.

Chlamydia in a pregnant woman causes complex changes in the fetal brain, edema, hemorrhage in the ventricles of the brain. Hemorrhagic chronic hypoxia reduces the delivery of nutrients to organs and tissues, promotes premature birth.

About cerebral hemorrhage

Intracranial hemorrhages often provoke birth injuries, they are accompanied by:

• tissue swelling;
• violation of cerebral circulation;
• deterioration of respiratory and cardiac activity;
• cerebellar rupture.

Risk group and causes of hemorrhage in infants

In premature babies, stroke often occurs, because by the end of pregnancy there is a complete disappearance of the germinal matrix. A minimal amount of blood enters the ventricles of the brain.

The appearance of hemorrhages in the germinal matrix is ​​facilitated by:

• hypoxia;
• the presence of hyaline membranes;
• breathing disorder;
• mechanical ventilation of the lungs.

In the process of treating a premature baby with large doses of sodium bicarbonate, irreversible consequences may occur:

• brain dehydration;
• increased intracranial pressure;
• circulatory disorders.

With a decrease in body temperature in a newborn, the following symptoms appear:

• blood clotting disorder;
• lowering blood pressure;
• acidosis;
• metabolic change.

Predisposing factors for the occurrence of hemorrhage in a child injured during childbirth are:

• gestational age of the fetus less than 37 weeks;
• reduced nutrition;
• underdevelopment of the capillary network;
• high blood clotting.

Types and degrees of hemorrhages

All types of perinatal pathology of cerebral blood supply have their own classification. Their distinguishing features are:

• etiology;
• clinical picture;
• morphology.

epidural

With fractures or cracks in the bones of the skull, a newborn develops epidural hemorrhage in the form of a hematoma. The reason for its appearance is a violation of the integrity of the vessels of the dura mater. The place of localization is the junction of the parietal and occipital bones. The hematoma looks like a convex lens.

There are two types of hemorrhages: pinpoint and spotty. The cause of the pathology is an anomaly of the ossification of the skull.

Subdural

Hemorrhage is characterized by the following symptoms:

• location between the dura mater and the arachnoid;
• bleeding;
• hemodynamic disorder.

Pathology is often accompanied by subdural bleeding as a result of rupture of cerebral vessels.
The main causes of hemorrhages are as follows:

• protracted childbirth;
• rigidity of the pelvic muscles of the woman in labor;
• the use of obstetric forceps and a vacuum extractor;
• pelvic presentation.

Subarachnoid

The classification of hemorrhages is determined by the following features:

• the nature of the foci of localization;
• the presence of blood clots;
• the number of areas of hemorrhage;
• their degree of distribution.

Often the reasons for the development of a stroke are:

• asphyxia;
• birth injury;
• DIC;
• violation of hemocoagulation;
• head configuration;
• lung damage, accompanied by venous congestion in the superior vena cava.

There are several types of hemorrhages:

• point;
• spotted;
• macrofocal.

The newborn has the following symptoms:

1. excitation;
2. hyperesthesia;
3. tension of a large fontanel;
4. trembling of the limbs;
5. breathing disorder;
6. regurgitation
7. convulsions.

The prognosis depends on the type of impact.

Intracerebral and ventricular

Subendymal hemorrhage involves brain tissue.

Ventricular pathologies are divided into several types:

1. without expansion of lateral cavities;
2. with the expansion of the ventricles;
3. with the movement of blood from 4 cavities to the cerebellum and brain stem.

Causes of pathology:

• rapid childbirth;
• bleeding;
• fetal hypoxia;
• the introduction of hypertonic solutions;
• increased intracranial pressure;
• hypothermia.

The clinical picture depends on the stage of the hemorrhage. The newborn develops:

• stupor;
• respiratory failure;
• tonic convulsions;
• gaze paresis;
• irregular heartbeat;
• acidosis.

In the 3rd stage of the disease, complications appear: irregular breathing, rare heartbeat, oculomotor disorders.

In the absence of effective assistance, a fatal outcome is possible.

Symptoms of hemorrhage in the brain of newborns

The severity of the patient's condition depends on timely diagnosis. Hemorrhage in the brain in a newborn is often manifested by clinical symptoms characteristic of subtentorial hemorrhage or is combined.

The doctor chooses one of 3 methods for eliminating the hematoma:

1. puncture;
2. craniotomy;
3. phased.

A craniotomy is performed when blood clots form. Puncture liquidation is used in a serious condition of the patient. The patient is injected with a tissue preparation that activates plasmogen, which accelerates the resorption of blood clots and blood clots.

To increase the survival rate of a premature baby, respiratory therapy is carried out for respiratory disorders that have arisen on the basis of cerebral hemorrhage. Curosurf is used for treatment. The therapeutic dose is 200 mg / kg, the drug is administered according to the scheme, depending on the gestational age of the premature baby.

At the same time, a sick child is prescribed:

1. study of indicators of heart contractions;
2. pulsometry;
3. CO₂ control by capnography.

In the event of the appearance of metabolic acidosis in a critically ill newborn, treatment is carried out aimed at stabilizing the ischemic myocardium and eliminating circulatory disorders.

Intravenous administration of the drug Trometamol reduces intracranial pressure. The medicine has the following effect:

• reduces cerebral edema;
• reduces inflammation in tissues;
• regulates daily diuresis.

For resuscitation use:

• hemostatics;
• dehydration therapy;
• broad-spectrum antibiotics;
• sedatives;
• painkillers.

To relieve convulsions in the acute period of subarachnoid hemorrhage, diazepam is administered intravenously to the patient. In the case of the development of neurogenic edema with large hemorrhages, beta-blocker Lebetalol and antipsychotics are used for treatment.

With central vascular spasm appoint:

• vasodilators;
• 25% magnesium sulfate solution.

For sedation therapy, the patient is recommended:

• propofol;
• benzodiazepine drugs.

In the event of a coma, emergency therapy is indicated:

• restoration of spontaneous breathing;
• fight against hypoglycemia.

Rehabilitation

Surviving children develop complications:

• hydrocephalus;
• encephalitis;
• atrophy of the white matter of the brain;
• lag in psychological and physical development.

The brain of a newborn has compensatory capabilities, so the child is given a course of rehabilitation. It includes the correction of psychoneurological and somatic disorders and drug and non-drug treatment.

Often the child develops arousal syndrome, the patient is concerned about:

• physical activity;
• excitation;
• muscle hypertension;
• motor dysfunction.

Rehabilitation measures can eliminate the violation of attention, difficulties in perception, imbalance of the nervous system.

The child is observed on an outpatient basis for at least 6 months.

Drug therapy is carried out, the patient is prescribed:

• psychostimulants;
• neuroleptics;
• nootropics.

• Piracetam;
• Phenibut;
• Pantogam;
• Cerebrolysin;
• Semax;
• Encephabol;
• Nicergoline;
• Vinpocetine;
• Instenon;
• Actovegin.

Forecast of later life

The course and outcome of the disease is influenced by:

• localization of hemorrhage;
• child's age.

Against the background of small hemorrhages, most newborns note a rapid recovery of lost functions. With moderate damage, the child often develops.

A severe injury with hemorrhage is often accompanied by: violation of autonomic functions, severe disability, death.