A newborn baby has a brain hemorrhage. Intracranial hemorrhage in newborns: causes, treatment

In newborns, lesions nervous system in the first hours of life can lead to a violation of adaptation, the development of disability and early death. Premature babies are most often affected. A cerebral hemorrhage in a newborn leads to neuropsychiatric disorders that are difficult to treat. In children born ahead of time, such a complication occurs in 60-90% of cases.

Why does brain hematoma occur?

For the development of pathology, it is necessary that there are changes in the structure of the brain or its vessels.

Brain hemorrhage in a newborn is dangerous for the nervous system

Hemorrhage occurs under the influence of several groups of factors, which are conventionally divided into:

• antenatal - the effect is in utero (that is, during pregnancy);
• intranatal - those that act at the time of childbirth;
• postnatal - act after the birth of a child.

A prerequisite for the occurrence of hemorrhage may be intrauterine infection, viruses are most often to blame. They can disrupt the formation of brain structures, cause malformations of the brain. Intranatal factors are preterm birth, which could happen due to detachment of a normally located placenta or against the background of the threat of interruption and uterine hypertonicity. Rapid childbirth is dangerous for the child, severe bleeding in the mother.

Postnatal factors are more often a reaction to medical intervention. The body of each premature baby is individual and has varying degrees adaptive capabilities. Therefore, he may respond to resuscitation and manipulation in different ways. Hemorrhage in the postnatal period can occur in the following cases:

• artificial ventilation of the lungs with high positive inspiratory pressure;
• excessive number of intravenous drips;
• multiple instrumental research requiring anesthesia;

Most often, hemorrhage occurs against the background of already existing disorders of cerebral blood flow, impaired permeability of the walls of blood vessels and / or disorders of the blood coagulation system.

More often hemorrhage is observed in premature babies born before 35 weeks. For them, not only birth trauma is dangerous, but also an increase blood pressure (arterial hypertension), which increases the permeability vascular wall- Under pressure, blood can seep through the walls of blood vessels.

What is dangerous hemorrhage

In children born prematurely, a breakthrough of blood most often occurs in the ventricles of the brain. These are physiological cavities in the brain that are normally filled with cerebrospinal fluid (CSF). The consequences of a hemorrhage may be as follows:

• blood forms clots that interfere with the normal outflow of cerebrospinal fluid. The accumulation of CSF leads to the development of hydrocephalus (an increase in head size and severe headaches in a child)
• the risk of infectious complications increases, since the blood is a good breeding ground for bacteria, most often the membranes of the brain (meningitis) become inflamed. As a result of inflammation, the membranes can become soldered, which can also lead to hydrocephalus;
• blood clotting is disturbed, which leads to bleeding in other organs;
• are damaged nerve cells, the child has neurological symptoms, up to disability.

Hydrocephalus occurs in 50% of children who have had an intraventricular hemorrhage. At severe forms hydrocephalus or, if left untreated, most children die due to compression of the brain. Survivors become severely disabled with impaired mental and physical development.

Classification of pathology

The type of cerebral hemorrhage is determined on the basis of a detailed questioning about the onset of the disease, clinical manifestations and examination of the newborn. The following types of intracranial hematomas (limited accumulation of blood) and hemorrhages (accumulation of blood without a clear boundary) are distinguished, all of which are life-threatening for the child and require emergency treatment:

• subdural hematoma - accumulation of blood under the dura mater, occurs during rapid labor due to irregular shape skull, accompanied by unexpressed neurological symptoms, may be accompanied by hemorrhage in the cerebellum;
• subtentorial hematoma - hemorrhage in the occipital part of the skull, is especially difficult and often requires emergency surgical treatment;
• epidural bleeding - the source is the vessels of the periosteum, which are damaged during a fracture or crack in the bones of the skull, require neurosurgical treatment in the coming hours;
• subarachnoid hemorrhage - the most common, occurs with asphyxia in childbirth (breathing arrest) and the birth of premature babies, can progress gradually with an increase in symptoms over several weeks;
• subepindymal hemorrhage - a consequence of rupture of small veins;
• intraventricular hemorrhages - a breakthrough of blood into the brain cavity, can develop acutely and subacutely.

Intraventricular hemorrhages are classified according to severity depending on the extent of the lesion, the degree of expansion of the ventricle, the presence of a breakthrough of blood to other departments and brain damage.

Cephalhematoma also refers to birth injuries. This is an accumulation of blood under the periosteum of the skull bone. Most often it is not dangerous, but sometimes it is combined with intracranial hemorrhage.

What are the symptoms of a hemorrhage?

The severity of symptoms of cerebral hemorrhage is different, some may appear in the first hours after birth, others take time. With a subdural hematoma, the condition of the newborn worsens gradually. The child is lethargic, the skin becomes pale. The newborn stops sucking and swallowing, the fontanel bulges and convulsions may begin.

With subarachnoid hemorrhages, the child spits up after feeding, sometimes vomiting occurs with a fountain. There are signs of an increase intracranial pressure: divergence of the sutures of the skull, tense or protruding fontanel. The following symptoms are observed:

• tilting the head, anxiety and crying of the child when trying to bend the head;
• trembling of the limbs;
• strabismus;
• convulsions of the muscles of the face and limbs;

Symptoms can persist for several weeks, parents should see a doctor as soon as possible to avoid serious complications. Such children in the future may suffer from mental retardation, seizures.

Hemorrhage in the ventricles of the brain manifests itself with varying degrees. In an acute course, the sucking and swallowing reflex disappears in a child within a few minutes / days, the child loses consciousness, and may stop breathing. The child has a fever and may develop seizures.

The subacute course of intraventricular hemorrhage is more easily tolerated.

It is not characterized by convulsions, but there may be strabismus, weak sucking, lethargy of the child.

Premature babies may experience combinations of several types of hemorrhages. Usually they are diagnosed already in the hospital. But parents need to carefully monitor the condition of the baby so as not to miss dangerous symptoms.

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 periventricular 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 incidence of other types of hemorrhage is very variable and does not of great importance, 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 temperature body;
• 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 care of a child, traumatic procedures, incorrect medicinal 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 when arterial hypertension, ischemia and venous congestion of the brain, with thrombosis, 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 shortness of breath 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.
• Celebrate eye symptoms: 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 biochemical analysis blood.

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 in 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 later a cyst is formed, since the brain tissue inside the hemorrhage is destroyed, this can be the cause of all kinds neurological disorders in a child, delays in mental and physical development.

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, childhood cerebral paralysis, meningoencephalitis, disorders of liquorodynamics 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.

Feeding children is carried out through a bottle, sucking milk from the breast is unsafe due to physical activity, children in serious condition are fed through a probe 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. Among surgical methods lumbar and ventricular punctures are used, blood is sucked from the foci of hemorrhage, liquor shunting tubes are installed. 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.

Ischemia-hypoxia, changes in blood pressure and pressure. The presence of the germinal matrix makes bleeding more likely. The risk is also increased in hematological disorders (eg, vitamin K deficiency, hemophilia, DIC).

Subarachnoid hemorrhage is probably the most frequent type intracranial hemorrhage. These newborns are characterized by apnea, seizures, lethargy, or unusual findings neurological examination. Large bleeding associated with meningeal inflammation can lead to hydrocephalus as the infant grows.

Subdural hemorrhage, now less common due to improvements in obstetric techniques, results from bleeding into the falciform space, tentorium, or commissure. Such bleeding tends to occur in newborns of nulliparous mothers, in large newborns, or after a complicated birth, conditions that can produce unusual pressure on the intracranial vessels. Symptoms may present with seizures; rapid head enlargement or abnormal findings on a neurological exam.

Intraventricular and/or intraparenchymal hemorrhages are the most serious type of intracranial bleeding. They are often bilateral and usually develop in the germinal matrix. Hypoxia - ischemia damages the capillary endothelium, reduces cerebral vascular autoregulation, and can increase cerebral blood flow and venous pressure, which make bleeding more likely. In most cases, intraventricular hemorrhages are asymptomatic.

Risk: risk in preterm infants intracerebral hemorrhage and its severity is directly proportional to the degree of immaturity:

• 25 weeks gestation - 50% risk.
• 26 weeks - 38%.
• 28 weeks - 20%.
• Statistics vary, sometimes significantly, between clinics.

manifestation time. In preterm infants, about 50% of hemorrhages appear on the 1st day of life, 25% on the second and 15% on the third.

Sources of bleeding:

Premature babies have a germinal matrix (regresses by 32-36 weeks of gestation) with vulnerable vessels (sensitive to pressure fluctuations, ischemia, hypoxia, acidosis, coagulation disorders). At 28-32 weeks' gestation, most of the terminal matrix is ​​located in the cauudothalamic junction, just posterior to the foramen of Monro. The IV ventricle also contains a vulnerable germinal matrix.

As the newborn matures, the value of the germinal matrix as a source of intracerebral hemorrhage decreases, and that of the choroid plexuses increases.

Classification of intracerebral hemorrhage in newborns

Advice. Instead of the above classifications (there are others), it is better to use a brief, precise description using the terms "germinal matrix", "intraventricular", "parenchymal" and indicating the location.

Papile classification- the most commonly used classification of hemorrhages in HH, based on computed tomography data:

• Hemorrhage II degree: with a breakthrough into the ventricle without its expansion.
• Hemorrhage III degree: with a breakthrough into the ventricle and its expansion.
• IV degree hemorrhage: a combination of I-III degree hemorrhage with hemorrhage in the brain parenchyma.

DEGUM classification(German Society for Medical Ultrasound). Developed by the pediatric department of DEGUM in 1998 and built on the basis of ultrasound data:

• Hemorrhage I degree: subependymal.
• Hemorrhage II degree: intraventricular with filling< 50 % просвета.
• Grade 111 hemorrhage: intraventricular with filling > 50% of the lumen.
• Parenchymal hemorrhages (cerebrum, cerebellum, basal ganglia, brainstem) are described separately (location and size).

Diagnosis of intracerebral hemorrhage in newborns

Intracranial hemorrhage should be suspected in a newborn with apnea, seizures, lethargy, or unusual neurological symptoms; these children should have a CT scan of the head. Although the ultrasound of the skull is not dangerous, CT is more sensitive for thin layers of blood. However, for screening very premature babies (eg,<30 нед гестации) некоторые врачи предпочитают проведение УЗИ. Если диагноз вызывает сомнение, СМЖ может быть проверена на содержание эритроцитов: она обычно содержит много крови. Однако некоторое количество эритроцитов часто присутствует в спинномозговой жидкости доношенных новорожденных.

In addition, blood tests, a complete blood count, and metabolic studies should be performed.

Ultrasound procedure

Premature babies need to perform cranial ultrasound on the first, third and seventh day of life. It also makes sense to perform an ultrasound after the child enters the department (in case of judicial investigations to clarify the time of the first manifestation of the lesion).

If a lesion is detected, a thorough examination of the midbrain and infratentorial structures through additional accesses (anterior and posterior lateral fontanelles) is necessary. Approximately 10% of preterm infants with posthemorrhagic ventricular dilatation have small cerebellar hemorrhages that are poorly visible through the large fontanel (this clinical problem is underestimated).

If a hemorrhage is detected near the arteries, especially in a full-term newborn, a Doppler study of the venous vessels (superior sagittal sinus, internal veins of the skull) is necessary.

In full-term, in addition to ultrasound, you need to perform an MRI and, if it matters for treatment, angiography.

Intraparenchymal areas with echo enhancement (the term periventricular venous soaking or edema is often used) are in most cases the foci of infarction. Sometimes they pass without the formation of cysts and then retrospectively we can only talk about venous congestion. After the onset of cystic transformation (weeks), the areas of echo amplification should be referred to as heart attacks or hemorrhages (important for talking with parents).

Differential Diagnosis

Unlike hemorrhages in premature infants, which are explained by immaturity, hemorrhages in full-term infants require a careful search for the cause: resuscitation, birth trauma, hemorrhagic diathesis (clotting and platelets), thrombophilia, venous and arterial thrombosis, embolism, polyglobulia, hypernatremia, aneurysms, arteriovenous malformations, coarctation of the aorta, tumor, ECMO therapy, etc.

Treatment of intracerebral hemorrhage in newborns

Treatment is predominantly supportive if hematologic abnormalities do not contribute to bleeding. All children should receive vitamin K if they have not received it before. In case of insufficiency of platelets or blood clotting factors, they must be replenished. Subdural hematomas should be treated by a neurosurgeon; it may be necessary to remove the hemorrhage.

Make the most of all the possibilities of conservative treatment:

• Stabilize blood pressure: avoid jumps in blood pressure, use catecholamines carefully, sedation. The principle of correction by minimal means.
• Normalization of oxygenation.
• Avoid hyper- and hypocapnia (decreased brain perfusion).
• Control of coagulogram, correction of deviations.
• Avoid hypoglycemia.
• Widespread use of anticonvulsants.

Attention: it is better to intubate electively than in an apnea emergency.

In full-term - early consultation of a neurosurgeon.

Prognosis of intracerebral hemorrhage in newborns

In preterm infants, grade I-II intracerebral hemorrhage probably does not significantly increase the risk of neurological complications.

The risk of severe neurological complications in premature infants with grade III hemorrhages is approximately 30%, with parenchymal hemorrhages - approximately 70%.

In mature neonates, prognosis depends on site and cause; hemorrhages in the basal ganglia, cerebellum and brain stem are unfavorable prognostically, but the individual course is unpredictable.

The prognosis for subarachnoid hemorrhage is generally good. For a subdural, be careful, but some babies do well. Most infants with small intraventricular hemorrhages survive an episode of acute bleeding and do well. Children with large intraventricular hemorrhage have a poor prognosis, especially if bleeding continues into the parenchyma. Premature infants with a history of severe intraventricular hemorrhage are at risk for developing posthemorrhagic hydrocephalus and should be carefully monitored with repeated cranial ultrasonography and frequent remeasurement of head circumference. Infants with progressive hydrocephalus require neurosurgical intervention for subcutaneous placement of a ventricular reservoir (for CSF aspiration) or a ventriculo-peritoneal shunt. The CSF associated with posthemorrhagic hydrocephalus has a very low glucose concentration, known as hypoglycorachia. Because many children remain neurologically deficient, careful observation and referral for early intervention is important.

This often happens with birth trauma. According to statistics, intracranial hemorrhage of the ICH) occurs in 1 out of 1000 cases in full-term babies. However, very premature babies born weighing less than 1.5 kg suffer much more often - hemorrhagic cerebral bleeding occurs in 20-45%.

The consequences of cerebral hemorrhage in newborns are always unfavorable, as they are fraught with such complications as neurological pathologies, hydrocephalus, cerebral palsy, cerebral edema, impaired vision, motor activity, speech apparatus, and even death. It all depends on the degree of hemorrhage, the place of its localization, the general condition of the baby and the compensatory abilities of the brain.

The reasons

As we have already found out, very preterm infants or full-term infants who have a history of intrauterine growth retardation are most at risk of developing pathology.

One of the first reasons can be considered chronic fetal hypoxia in the week of pregnancy. The fact is that during this period, the periventricular space is literally permeated with a large number of vessels that play an important role at this stage, but eventually cease to carry functionality. In the event of complications and lack of oxygen during these weeks, hemorrhages may form, which will worsen during childbirth under the influence of mechanical pressure.

Other causes of cerebral hemorrhage are as follows:

• lack of vitamin K and K-dependent factors, other anomalies associated with the coagulation process (blood clotting);
• pathologies against the background of severe hypoxia: acidosis, too strong activation of fat peroxidation, low blood pressure;
• intrauterine infections with viruses, mycoplasmas that contribute to the destruction of the walls of blood vessels;
• chronic diseases of the mother (for example, diabetes mellitus);
• the influence of women's addictions (smoking, alcoholism);
• trauma during childbirth due to narrow birth canals and a large fetal head, with rapid labor, caesarean section;
• the use of obstetric aids (vacuum extraction of the fetus, obstetric forceps).

Types and degree of damage

The brain, like our other organs, has an impressive network of blood and lymph vessels, small and large, delivering oxygen to it and protecting the brain center from germs and viruses. The skull is covered on top with a hard shell, called in Latin "dura mater". If the hemorrhage occurs under this shell, it is called subdural, if between the shell and the skull, then epidural.

This is followed by arachnoid (arachnoid in medicine) and pia mater. Between them is the subarachnoid space filled with CSF (cerebrospinal fluid). The cavities that CSF fills are called ventricles.

They say about subarachnoid hemorrhage when a rupture of the vessel occurred in the space between the arachnoid and pia mater. If the blood filled one or more ventricles, we are talking about intraventricular hemorrhage (hereinafter abbreviated IVH). Another epithelial layer that protects the brain is called the ependyma. Rupture of the vessel in this area leads to subependymal hemorrhage.

The degree of severity is judged depending on which part of the brain or its membrane is damaged and how extensive its damage is:

• 1 degree of severity - subependymal hemorrhage (hereinafter abbreviated SEC);
• Grade 2 - blood partially or completely penetrates into the lateral ventricle, but does not change its size;
• Grade 3 - the ventricle, filling with blood, increases in size;
• Grade 4 - blood overflows the ventricles, expanding them, and goes beyond them, entering the substance of the brain in newborns.

According to the ICD-10 classification, the division of hemorrhages occurs as follows:

• subependymal;
• IVH without penetration into the parenchyma (tissue) of the brain;
• IVH with penetration into the brain parenchyma.

Various diagnostic formulations sometimes confuse in making the correct diagnosis, therefore, when deciding on a treatment regimen, the doctor focuses on the results of an ultrasound examination, MRI or X-ray.

Signs of cerebral hemorrhage do not always appear immediately. Pathology can proceed the first day asymptomatically.

Symptoms

The clinical picture, depending on the localization of vascular damage, will be somewhat different, but in general, the characteristic signs of hemorrhage in infants are identified:

• a sharp deterioration in the condition, the symptoms of hyperexcitability are replaced by signs of depression;
• the fontanel swells strongly, is in tension;
• the strength and nature of the baby's cry changes;
• convulsive activity;
• peripheral circulatory disorders, palpitations, frequent regurgitation, weight loss, increased gas formation, shortness of breath, apnea;
• anemic syndrome, decrease in hemoglobin in the blood;
• an increase in the blood of ketone bodies, bilirubin, which poisons the body with toxins;
• development of renal, cardiovascular insufficiency;
• accession of a secondary infection, as a result of which the development of sepsis, meningitis, pneumonia is possible.

Now we characterize the clinical picture in individual situations:

One of the most common forms of hemorrhage. There are no specific symptoms of SEC. Its most important manifestation is considered to be repeated bouts of apnea in the first days of a newborn's life. Diagnosis is made only after neurosonography.

Indirect signs of the disease are expressed in moderate tilting of the head, muscle weakness of the arms of the first or second degree, Graefe's symptom along with increased mobility of the eyeballs, and in symptoms of mild depression/excitation. As a result of SEC, a cyst often forms.

Intraventricular hemorrhage in newborns

With hemorrhage in the ventricles of the brain of 1 and 2 severity, there are no visible symptoms and can pass without the development of neurological pathologies. However, in more severe cases, swelling of the fontanelles, convulsions, malfunctions in the work of breathing and the cardiovascular system are observed. Then lethargy sets in, reflexes and motor activity are inhibited, the head may increase in size.

All this happens due to an increase in fluid volume, a sharp increase in intracranial pressure and, as a result, cerebral edema and compression of the nerve centers responsible for various work in our body.

If blood erupts from the lateral ventricles into the brain tissue, the hemorrhage is identified as parenchymal

epidural and subdural

Simply put, it is a hematoma, a bag of accumulated blood between the skull and the dura mater. In children, it develops due to mechanical pressure during childbirth. Symptoms have 2 phases: convulsions and a decrease in all reflexes and functions of organs up to loss of consciousness, then "enlightenment" occurs.

With subdural hemorrhage, the picture is almost the same, so that the differences are made only with the help of diagnostic methods.

Subarachnoid

As in previous cases, the clinical picture is very variable. The first 2-3 days there may not be any visible violations. Then the processes of excitation/oppression alternate. Even with the development of seizures in the intervals between them, the child looks completely healthy. The prognosis and the need for treatment will again depend on the extent of the lesion.

Diagnosis and treatment

Diagnosis is based on the results of ultrasound examination through the fontanel and computed tomography, as well as judging by blood tests.

Treatment of the acute phase is carried out in special conditions while maintaining the desired temperature and ventilation. Therapy is aimed at reducing intracranial pressure and reducing swelling of the brain. At the same time, it is necessary to maintain cerebral blood flow.

With the help of CT, you can see the extent of the hemorrhage and its localization.

If this treatment fails, surgery is indicated: shunting.

Separately, I want to say about hemorrhage in the adrenal glands in newborns. In severe hypoxia or improper delivery, adrenal hemorrhages are possible, which, if not treated on time, are fatal. If such a pathology is detected, treatment is aimed at compensating for the deficiency of the adrenal hormone, increasing blood pressure, anti-shock therapy, restoring water and electrolyte balance and fighting infection, if any.

Prevention

It is impossible to calculate everything to the smallest detail and be safe from all diseases. Therefore, in this situation, prevention comes down to treating your pregnancy responsibly, being examined by a gynecologist in time and, if necessary, being treated. It is in our power to choose a maternity hospital and a doctor for delivery, whom we trust. But the delivery process is sometimes so unpredictable that you do not know what complications may arise. Therefore, it is also important for parents to remain calm, not to wind themselves up, and after the baby is born, to provide him with proper care.

ATTENTION! All information on the site is for informational purposes only and does not claim to be 100% accurate. No need to self-medicate!

Hemorrhage in newborns

After childbirth, especially if they had complications, the baby is under the close supervision of obstetricians. And if there is unexpected anxiety and excessive motor activity, which are replaced by drowsiness, lethargy with a general decrease in body temperature and cooling of the extremities, this can be an alarming sign of intracranial hemorrhage in a newborn. What is fraught with this condition and what treatment does it require?

Causes of hemorrhage in newborns

Intracranial hemorrhage in a newborn is found in 1-2% of cases, and more often it occurs in the meninges than in the brain tissues. This condition occurs due to rupture of blood vessels inside the skull, caused by damage to the skull or hypoxia.

Modern studies have shown that the factors that can provoke such a pathology in a newborn are:

• Prematurity or postmaturity;
• Too large head of the baby and / or narrow birth canal of the mother;
• Intrauterine infections;
• Protracted or rapid course of childbirth;
• obstetric interventions.

At the slightest suspicion of a hemorrhage in a newborn, and these can be apnea, convulsions, impaired consciousness and neurological symptoms, a computed tomography of the baby's head is performed.

Types and symptoms of pathology

Hemorrhages in newborns are classified into epidural, subdural, subarachnoid and intraventricular.

Epidural hemorrhages are localized between the bones of the skull and the hard shells of the brain and can occur when the vault of the skull bones is damaged. In this case, the characteristic signs will be the expansion of the pupil of the eye, from which the damage occurred, slow heart rate, low blood pressure, suffocation and convulsions. Tellingly, in the first 3-6 hours the baby behaves absolutely calmly, but then he shows signs of brain compression, which can lead to a coma within a day.

Subdural hemorrhages in newborns are localized between the soft and hard shells of the brain and are most often observed during prolonged labor of a large fetus due to displacement of the skull plates. Because modern delivery techniques minimize these injuries, bleeding of this type is virtually non-existent today. It can have long-term consequences in the form of neurological disorders and high levels of bilirubin, but timely treatment can avoid this.

Subarachnoid hemorrhages in newborns occur more often in premature babies in the area between the arachnoid membrane and the substance of the brain and are the result of prolonged labor with obstetric intervention. The most severe consequence of this pathology is meningitis. In this case, the symptoms of cerebral hemorrhage in newborns appear immediately after childbirth or within a few days: there is general arousal, insomnia, anxious facial expressions, a violent reaction to stimuli, and an unreasonable cry. The baby can lie with his eyes open for a long time, the circumference of his head increases due to the divergence of the bones of the skull, the occipital muscles tense up, convulsions and strabismus are observed. With timely treatment, the condition eventually returns to normal without serious consequences.

Intraventricular hemorrhage in newborns occurs in cavities filled with cerebrospinal fluid, as a rule, with a strong degree of prematurity and slow intrauterine development, which is very likely during childbirth before 32 weeks of gestation.

Treatment of intracranial hemorrhage in a newborn

Treatment of a subdural hematoma requires the intervention of a neurosurgeon to remove the blood. In all other cases, supportive therapy is prescribed, including vitamin K, and, if necessary, a thrombus mass preparation or blood clotting factors.

Consequences of hemorrhage in a newborn

As a rule, the consequences of a hemorrhage in a newborn depend on the degree of vascular damage, but factors such as the severity of the disease that caused the pathology, the presence of concomitant infections and the complexity of their course also play a role. Recovery will depend on adequate treatment and the creation of an environment that stimulates the normal development of the child. With the right actions of doctors, the baby very quickly catches up with his peers.

Text: Marina Kudryavtseva

What does grinding teeth mean in children?

Concern for the well-being of the child is the main thing for mom and dad. One can understand the amazement and anxiety of parents when they notice that a completely healthy baby periodically creaks and grinds his teeth. The problem is usually

What diseases await us in the office

At first glance, the working conditions of office workers seem to be forgiving. Warm, comfortable room, comfortable furniture, calm and measured days without emergency work, overtime and night shifts. Grace. No matter how p.

How comfort smells: using essential oils at home

Have you noticed that hypermarkets always smell delicious? The wonderful aroma of cinnamon or vanilla is distributed on the trading floor for a reason: it is marketing.

Menses while breastfeeding

Menstruation after abortion

What should be the chair of a newborn

Discharge after an abortion

When using materials from the site, the active reference is obligatory

Intraventricular hemorrhage (IVH) in newborns: causes, degrees, manifestations, prognosis

Neurological pathology in newborns and children of the first years of life is a very serious problem, and, unfortunately, brain damage in babies is by no means uncommon. IVH is intraventricular hemorrhage, which is very characteristic of the neonatal period and often accompanies the pathological course of childbirth.

Intraventricular hemorrhages are also found in adults, representing one of the forms of stroke with high mortality. As a rule, blood at the same time penetrates into the ventricular system from intracerebral hematomas when they break through into the brain cavity.

Hemorrhage into the ventricles of the brain in children is usually isolated, not associated with parenchymal hematomas, that is, it can be considered as an independent separate disease.

intraventricular hemorrhage in a newborn

The significance of the problem of intraventricular hemorrhage in newborns is due not only to the difficulties of diagnosing and treating pathology, because many drugs are contraindicated for babies, and immature nervous tissue is extremely sensitive to any adverse circumstances, but also to a prognosis that can not always reassure young parents.

In addition to children born during the abnormal course of the birth period, IVH is diagnosed in preterm infants, and the shorter the gestation period at which premature birth occurred, the greater the likelihood of IVH and the more severe the degree of ischemic-hypoxic brain damage.

In babies born prematurely, half of the hemorrhages in the ventricles occur already on the first day of life, up to 25% of IVH occurs on the second day after birth. The older the child, the less the likelihood of circulatory disorders in the brain, even under the condition of an abnormal course of childbirth.

To date, the arsenal of neonatologists has highly informative research methods that allow timely diagnosis of intraventricular hemorrhage, but problems with classification, determining the stage of pathology have not yet been resolved. A unified classification of IVH has not been developed, and when formulating the stages, the features of the topography of the lesion are taken into account rather than the clinical severity and prognosis.

Causes of intraventricular hemorrhages in newborns

The causes of IVH in young children are fundamentally different from those that cause hemorrhages in adults. If in the latter vascular factors come to the fore - hypertension, atherosclerosis underlying strokes, and the very penetration of blood into the ventricles is secondary to intracerebral hematoma, then in newborn babies the situation is somewhat different: hemorrhage immediately occurs inside the ventricles or under their lining , and the reasons are somehow related to pregnancy and childbirth:

• state of prematurity;
• Long waterless period;
• Severe hypoxia in childbirth;
• Obstetric injuries (rare);
• Birth weight less than 1000 g;
• Congenital disorders of blood coagulation and vascular structure.

In premature babies, the presence of the so-called germinal (embryonic matrix) is considered as the main cause of intraventricular hemorrhages, which should gradually disappear as the fetal brain and vascular system mature. If the birth occurred prematurely, then the presence of this structure creates the prerequisites for IVH.

The germinal matrix is ​​a region of neural tissue around the lateral ventricles containing immature cells that migrate to the brain and mature to become neurons or neuroglial cells. In addition to cells, this matrix carries immature capillary-type vessels, the walls of which are single-layered, therefore they are very fragile and can break.

Hemorrhage into the germinal matrix is ​​not yet IVH, but it most often leads to the penetration of blood into the ventricles of the brain. A hematoma in the nervous tissue adjacent to the wall of the ventricle breaks through its lining, and blood rushes into the lumen. From the moment of the appearance of even a minimal volume of blood in the ventricle of the brain, one can speak of the onset of an independent disease - intraventricular hemorrhage.

Determining the stages of IVH is necessary to assess the severity of the disease in a particular patient, as well as to determine the prognosis in the future, which depend on the amount of blood that has entered the ventricles and the direction of its spread towards the nervous tissue.

Radiologists base IVH staging on the results of computed tomography. They highlight:

• IVH of the 1st degree - subependymal - blood accumulates under the lining of the ventricles of the brain, without destroying it and without entering the ventricle. In fact, this phenomenon cannot be considered a typical IVH, but at any time a breakthrough of blood into the ventricles can occur.
• IVH of the 2nd degree is a typical intraventricular hemorrhage without expansion of its cavity, when blood exits from the subependymal space. On ultrasound, this stage is characterized as IVH with less than half of the volume of the ventricle filled with blood.
• IVH grade 3 - blood continues to flow into the ventricle, filling more than half of its volume and expanding the lumen, which can be seen on CT and ultrasound.
• IVH of the 4th degree is the most severe, accompanied not only by the filling of the ventricles of the brain with blood, but also by its spread further into the nervous tissue. CT shows signs of IVH of one of the first three degrees along with the formation of foci of parenchymal intracerebral hemorrhage.

Based on structural changes in the brain and its cavities, three stages of IVH are distinguished:

1. At the first stage, the ventricles are not completely filled with blood contents, they are not dilated, spontaneous cessation of bleeding and the preservation of normal liquorodynamics are possible.
2. Continued filling of the lateral ventricles with possible expansion when at least one of the ventricles is filled with blood by more than 50%, and the blood spreads to the 3rd and 4th ventricles of the brain occurs in the second stage.
3. The third stage is accompanied by the progression of the disease, the ingress of blood under the choroid of the cerebellum, medulla oblongata and spinal cord. High risk of fatal complications.

The severity of IVH and its manifestations will depend on how quickly the blood penetrated into the brain tissue and its cavity, as well as on its volume. Hemorrhage always spreads along the course of the flow of cerebrospinal fluid. In severely premature babies, as well as those who have undergone deep hypoxia, disturbances in the blood coagulation system occur, so clots in the brain cavities do not appear for a long time, and liquid blood “spreads” freely throughout the brain regions.

At the heart of the CSF circulation disorder and the subsequent increase in hydrocephalus is the penetration of blood into the ventricle, where it mixes with the cerebrospinal fluid, but does not immediately clot. Part of the liquid blood penetrates into other cavities of the brain, but as it coagulates, its clots begin to block the narrow zones through which the CSF circulates. The blockage of any of the openings of the brain entails a blockade of the CSF pathway, expansion of the ventricles and hydrocephalus with characteristic symptoms.

IVH manifestations in young children

Up to 90% of all hemorrhages in the ventricular system occur in the first three days of a baby's life, and the lower its weight, the higher the likelihood of pathology. After the first week of a child's life, the risk of hemorrhage is significantly reduced, which is associated with the adaptation of the vascular system to new conditions and the maturation of the structures of the germ cell matrix. If the child was born prematurely, then for the first days he should be under the close supervision of neonatologists - for 2-3 days the condition may deteriorate sharply due to the onset of IVH.

Small subependymal hemorrhages and grade 1 IVH may be asymptomatic. If the disease does not progress, then the condition of the newborn will remain stable, and neurological symptoms will not even occur. With multiple hemorrhages under the ependyma, signs of brain damage will appear closer to the year with leukomalacia.

A typical intracerebral hemorrhage is manifested by symptoms such as:

• Decreased muscle tone;
• Flaccid tendon reflexes;
• Respiratory disorders up to a stop (apnea);
• convulsions;
• Focal neurological symptoms;
• Coma.

The severity of the course of the pathology and the features of the symptoms are associated with the volume of blood that has entered the ventricular system and the rate of pressure increase in the cranial cavity. Minimal IVH, which does not cause obstruction of the CSF tract and changes in ventricular volume, will be accompanied by an asymptomatic course, and it can be suspected by a decrease in the hematocrit number in the baby's blood.

A spasmodic flow is observed with moderate and submassive IVH, which are characterized by:

1. Oppression of consciousness;
2. Paresis or muscle weakness;
3. Oculomotor disorders (histagmus, strabismus);
4. Respiratory disorders.

Symptoms with an intermittent course are expressed for several days, after which they gradually decrease. Both a complete recovery of brain activity and minor deviations are possible, but the prognosis is generally favorable.

The catastrophic course of IVH is associated with severe disorders of the brain and vital organs. Characterized by coma, respiratory arrest, generalized convulsions, cyanosis of the skin, bradycardia, lowering blood pressure, violations of thermoregulation. Intracranial hypertension is evidenced by the bulging of the large fontanel, which is clearly visible in newborns.

In addition to clinical signs of impaired nervous activity, there will be changes in laboratory parameters. The occurrence of IVH in newborns may be indicated by a drop in hematocrit, a decrease in calcium, fluctuations in blood sugar, blood gas disorders (hypoxemia), and electrolyte disturbances (acidosis) are not uncommon.

The progression of bleeding leads to the spread of blood from the ventricles into the cisterns of the brain and nervous tissue. Parenchymal intracerebral hematomas are accompanied by gross focal symptoms in the form of paresis and paralysis, sensory disturbances, generalized convulsive seizures. When IVH is combined with intracerebral hemorrhage, the risk of an unfavorable outcome is extremely high.

Among the long-term consequences of IVH, ischemic-hypoxic damage and residual changes in the brain in the form of cysts, periventricular leukomalacia, white matter gliosis, and cortical atrophy are noted. By about a year, a developmental lag becomes noticeable, motor skills suffer, the child cannot walk and perform the correct movements of the limbs in due time, does not speak, and lags behind in mental development.

Diagnosis of IVH in infants is based on an assessment of symptoms and examination data. The most informative is CT, neurosonography and ultrasound. CT is accompanied by radiation, so it is preferable for premature babies and newborns of the first days of life to conduct an ultrasound examination.

IVH on a diagnostic image

Treatment and prognosis

Children with IVH are treated by neurosurgeons and neonatologists. Conservative therapy is aimed at restoring the functioning of vital organs and blood counts. If the child did not receive vitamin K at birth, then it must be introduced. Deficiency of coagulation factors and platelets is replenished by transfusion of plasma components. When breathing stops, artificial ventilation of the lungs is performed, but it is better to establish it as planned if there is a risk of respiratory disorders.

Medical therapy includes:

• Normalization of blood pressure to prevent a sharp decrease or jumps that aggravate hypoxia and damage to the nervous tissue;
• oxygen therapy;
• anticonvulsants;
• Blood clotting control.

To reduce intracranial pressure, the introduction of magnesium sulfate intravenously or intramuscularly is indicated, diacarb, furosemide, veroshpiron are used for full-term children. Anticonvulsant therapy consists in the appointment of diazepam, valproic acid preparations. To relieve symptoms of intoxication, infusion therapy is carried out, acidosis (acidification of the blood) is eliminated by using a solution of sodium bicarbonate intravenously.

In addition to medication, surgical treatment of IVH is carried out: evacuation of blood from the ventricles of the brain by means of their puncture under ultrasound control, the introduction of fibrinolytic agents (actelyse) into the lumen of the ventricles to prevent thrombosis and occlusive hydrocephalus. Perhaps a combination of puncture with the introduction of fibrinolytic drugs.

In order to remove tissue decay products and eliminate the symptoms of intoxication, liquor filtration, liquor sorption and intraventricular lavage with artificial cerebrospinal fluid preparations are indicated.

With blockage of the cerebrospinal fluid and hydrocephalic syndrome, temporary drainage of the ventricles is established with the evacuation of blood and clots until the cerebrospinal fluid is cleared and the obstruction of its outflow pathways is eliminated. In some cases, repeated lumbar and ventricular punctures, external ventricular drainage, or temporary internal drainage with implantation of artificial drainage under the skin are used.

insertion of a ventricular drainage catheter

If hydrocephalus has acquired a persistent and irreversible character, and there is no effect from fibrinolytic therapy, then neurosurgeons provide permanent drainage by surgery:

1. Installation of permanent shunts with CSF outflow into the abdominal cavity (a silicone tube passes under the skin from the head to the abdominal cavity, the shunt can be removed only if the child's condition stabilizes and there is no progression of hydrocephalus);
2. Endoscopic imposition of anastomoses between the ventricles of the brain and the basal cisterna.

The most common method of surgical treatment of occlusive hydrocephalus associated with IVH is ventriculoperitoneal drainage. It is affordable, allows drugs to be injected into the ventricles, has a low likelihood of infection, can be carried out for a long time, and care for the child is not accompanied by difficulties. The use of alteplase, which accelerates the dissolution of blood clots in the ventricles, can reduce mortality and maximize brain function.

The prognosis for IVH is determined by the stage of the disease, the amount of hemorrhage, and the location of brain tissue damage. In the first two degrees of IVH, blood clots resolve themselves or under the influence of treatment, without causing significant neurological disorders, therefore, with small hemorrhages, the child can develop normally.

Massive intraventricular hemorrhages, especially if they are accompanied by damage to the brain tissue, can lead to the death of an infant in a short time, and if the patient survives, then it is problematic to avoid neurological deficit and gross violations of psychomotor development.

All children with intracranial hemorrhages are subject to careful observation in intensive care and timely surgical treatment. After installing a permanent shunt, the disability group is determined, and the baby should be regularly shown to a neurologist.

To avoid the severe changes described, it is important to observe measures to prevent brain damage in newborns and very premature babies. Expectant mothers need to undergo the necessary preventive examinations and examinations in a timely manner, and with the threat of premature birth, the task of obstetrician-gynecologists is to prolong the pregnancy as much as possible with medications until such a time when the risk of hemorrhages becomes minimal.

If the child is still born prematurely, then he is placed in the intensive care unit for observation and treatment. Modern methods of diagnosis and therapy of IVH can not only save the lives of babies, but also significantly improve their quality, even if this requires a surgical operation.

Brain hemorrhage in a newborn: causes, symptoms and treatment of premature babies

Hemorrhage in the brain of a newborn is one of the most complex birth injuries affecting the central nervous system. In this condition, the child's skull is damaged, as a result of which a blood vessel in the brain is torn.

Features and risk factors

Many factors can provoke intracranial bleeding. This is due both to pathological pregnancy and to the banal negligence of doctors. In this case, the vessel can burst in any area of ​​the child's brain.

The causes of hemorrhage in infants largely depend on the period at which they were born. Most often, such a pathology is provoked by the following factors:

1. Premature birth (before 32 weeks), especially if the pregnancy was accompanied by prolonged toxicosis.
2. Rapid or prolonged labor, which are considered pathological and cause brain hypoxia in the fetus.
3. Use of obstetrical forceps that damage the baby's skull.
4. Postponed pregnancy. In this condition, the baby's skull bones lose their elasticity, increasing the risk of injury during childbirth.
5. The defeat of intrauterine infection.
6. Too large fetus in a woman with a narrow pelvis.
7. Various vices in children.

Remember! Premature babies have a 50% risk of trauma during childbirth with further intracranial hemorrhage. The highest probability of pathology in this case is in babies weighing less than 1.5 kg.

Types and symptoms of cerebral hemorrhages

Common signs of cerebral hemorrhage in children are:

• lethargy;
• disturbance of consciousness;
• increased reaction even to a small stimulus;
• convulsions;
• critical weight loss;
• frequent vomiting;
• increased intracranial pressure;
• poor appetite.

Additional symptoms may occur depending on the specific type of lesion and the location of the hemorrhage.

This pathology has the following varieties:

1. Subarachnoid lesion. It is typical for premature babies, as well as with the use of auxiliary manipulations during childbirth. In this state, there is damage to the vessels over the substance of the brain, which leads to strabismus, constant screaming, convulsions, disturbed sleep.
2. epidural view. This pathology leads to damage to the vessels that are under the bones of the skull. A complication develops with a post-term pregnancy or rapid delivery. Symptoms of such a hemorrhage will be low blood pressure, convulsions, hypoxia, and a dilated pupil on the affected side of the head.
3. Subdural view. Pathology is accompanied by the accumulation of blood between the meninges. Most often it is observed with a large fetus and a narrow pelvis in women. This complication can lead to a number of neurological disorders and high bilirubin in the blood.

Important! The period of the first week after the birth of a child is considered the most dangerous, when the initial symptoms of hemorrhage are detected. If deterioration is not observed after the second week of the baby's life, then the prognosis becomes more favorable.

Diagnostics

An experienced doctor can suspect such a complication in an infant by the characteristic manifestations of the disease. To clarify the diagnosis, the baby should conduct several important studies.

Initially, CT diagnostics is prescribed. This is the most accurate method, which is very informative in case of brain damage. He will not only identify the focus of the pathology, but will also be able to detect the type of hemorrhage.

Additionally, a coagulogram, general blood tests and EEG should be performed.

If the diagnosis is confirmed, urgent hospitalization and treatment are required.

Treatment

Treatment of cerebral hemorrhage in children depends on neglect (grade 1, 2 or 3) and the type of pathology. In this case, a specific course of treatment is selected by the attending physician on an individual basis for each individual baby. In this case, the doctor must take into account the neglect of the condition, the symptoms and the severity of brain damage.

The acute period of the disease needs to restore the functions of the brain, heart and respiration. The general course of therapy is aimed at normalizing blood circulation.

If necessary, the newborn is provided with urgent resuscitation assistance.

To reduce the risk of pulmonary edema and all the ensuing consequences, diuretics (Sudoxen) are used.

A puncture is performed to reduce intracranial pressure.

With severe bleeding, drugs Vikasol or calcium Chloride are prescribed.

To restore important trace elements in the body, the course of treatment includes Glucose, Sodium sulfate, Panangin.

To help your child, parents should follow these tips:

• do not self-medicate and immediately agree to the hospitalization of the baby;
• keep breastfeeding as long as possible;
• fulfill all medical prescriptions;
• carry out the necessary hygiene measures for the newborn;
• do not leave crying unattended.

Possible complications

The brain of infants has excellent ability to recover, therefore, with a slight pathology, the prognosis for the baby is favorable, and he will be able to develop normally. The recovery process takes from 5 months to 2 years.

In more severe cases, the consequences can remain with the child for life. In this condition, the baby can develop the following complications:

• epilepsy;
• developmental disorder;
• neurological disorders;
• fatal outcome.

Remember! Intraventricular hemorrhages are usually small, so they respond well to treatment and can pass without a trace in a child. If the baby has a profuse hemorrhage in the ventricles, then the question of surgical intervention may be raised.

Rehabilitation

In the first days after the detection of pathology, the child should be under constant medical supervision. Usually these babies are transferred to intensive care.

To improve the condition of the baby, his crib should be positioned so that the head end is slightly raised. Ice is placed at a distance of 30 cm from the patient's head. A heating pad is placed near the feet.

In the first week of the newborn, you need to breastfeed. In case of violation of the swallowing function, a probe is inserted.

With the normalization of the child's condition and after the end of drug therapy, a rehabilitation course should be carried out. It includes massage and special gymnastics. As the child grows older, they may need swimming lessons and speech therapy lessons.

Also, without fail, such patients should be regularly observed by a doctor (pediatrician, neuropathologist, orthopedist).

Preventive measures

Unfortunately, it is impossible to completely prevent cerebral hemorrhage in newborns, since childbirth is always an unforeseen process, and even the most favorable pregnancy does not guarantee complications after.

To reduce the risk of negative consequences, a woman should follow these tips:

1. The entire pregnancy is periodically monitored by a doctor.
2. Take care of your health and avoid stress.
3. Refuse hard physical work, which can cause premature birth.
4. Timely treat infectious diseases that can harm the fetus and provoke complications.
5. Give up bad habits (smoking, drinking alcohol) and adhere to proper nutrition.
6. Carefully approach the choice of clinics and the doctor who will take delivery.

It is also worth remembering that if the fetus is large, and the woman's pelvis is too narrow, then it would be wiser to perform a caesarean section. This will protect against unwanted consequences.

A cerebral hemorrhage in a newborn is considered a very dangerous pathology that must be addressed immediately. Even if, after discharge from the maternity hospital, parents notice signs of brain damage, they should consult a doctor as soon as possible in order to be able to prevent serious complications.

The birth of a baby is a responsible, complex and often unpredictable process. It happens that as a result of childbirth, the child receives severe injuries, for example, hemorrhages in the brain. What leads to such situations, what can be the consequences, and can a positive outcome be expected with timely treatment?

The reasons

Hemorrhage in the tissues and membranes of the brain in an infant is due to rupture of blood vessels. Such a pathological process may be the result of hypoxic damage or damage to the skull of a newborn during childbirth.

Prerequisites for hemorrhage are:

• discrepancy between the size of the baby's head and the birth canal;
• prematurity or postmaturity;
• severe pregnancy (intrauterine mycoplasmal and viral infections that cause damage to the vascular walls);
• rapid or, conversely, prolonged labor;
• improper delivery by caesarean section and the imposition of obstetric forceps, chronic intrauterine hypoxia, vacuum extraction of the fetus.

Classification

Depending on which area of ​​the brain the rupture of blood vessels occurred, there are:

• hemorrhages in the ventricles and substance of the brain;
• epidural hemorrhages;
• subdural hemorrhages;
• subarachnoid hemorrhages.

Hemorrhages in the ventricles and substance of the brain are usually found in premature babies who have a slow intrauterine development of the brain. Babies born before 32 weeks of gestation are at risk.

The most common signs of intraventricular bleeding in newborns are muscle hypotonia, episodes of apnea, drowsiness, disappearance or decrease in the Moro reflex. In premature babies, the pathology is manifested by a sharp deterioration in the state of health on the 2nd-3rd day of life: cyanosis, pallor, episodes of apnea, refusal to eat, weak or shrill cry, metabolic acidosis, oculomotor disorders, muscle hypotension or paresis, convulsions, bulging of the large fontanel, shock .

With extensive damage to blood vessels, accompanied by hemorrhages in the cerebral cortex, the consequences can be irreversible - cerebral palsy, behavioral problems.

epidural hemorrhages- occur in newborns with rupture of blood vessels between the dura mater and the bones of the skull. This pathological process develops when the bones of the cranial vault are damaged. Its signs are: dilatation of the pupil on the damaged side, low blood pressure, bradycardia, suffocation, clonic-tonic convulsions.

Epidural intracranial bleeding in infants is characterized by a quiet interval (within 3-6 hours). Then the brain compression syndrome develops, which is manifested by a sharp deterioration in the baby's condition, up to the development of a coma after a couple of days.

subdural hemorrhages- occur when blood vessels rupture between the hard and soft shells of the brain. Currently, such hemorrhages develop quite rarely, thanks to the improvement of obstetric care. This type of pathology occurs during the first birth, as well as due to prolonged or rapid delivery of a very large fetus. The first symptoms may be seizures, neurological disorders (weak Moro reflex, hypotension), retinal hemorrhage, or a rapidly growing head.

The consequences depend on how quickly the injury is detected, its causes are established and therapy is started. Subdural hemorrhages can lead to the development of neurological disorders and an increase in the level of bilirubin in the blood.

Subarachnoid hemorrhages – the most common type of hemorrhage in newborns. Such hemorrhages occur, as a rule, in premature babies with damage to the vessels in the space between the substance of the brain and the arachnoid. They can be provoked by prolonged labor with obstetric intervention.

The following symptoms are characteristic of subarachnoid hemorrhages: constant crying, general excitement of the newborn, sleep disturbance, alert, anxious expression on the child's face, prolonged lying of the infant with eyes open, violent reaction to any irritant, tension of the occipital muscles, an increase in head circumference, provoked by the divergence of the bones of the skull, convulsions, strabismus.

With this type of brain damage in premature babies, the degree of consequences is insignificant. If treatment is started in a timely manner, the child's condition will return to normal soon.

Treatment

With intraventricular hemorrhages, therapy is aimed at eliminating the complications of the pathological process. Massive blood loss and shock require transfusion of fresh frozen plasma and red blood cells, and convulsions require active anticonvulsant therapy. It is also necessary to correct acidosis, incl. sodium bicarbonate.

The presence of epidural hemorrhage in most cases is an indication for urgent surgical intervention. When removing a hematoma, it is necessary to control blood loss with replenishment of the volume of circulating blood (BCC).

Treatment of subarachnoid hemorrhage begins with the correction of respiratory, metabolic and cardiovascular disorders. To remove blood, lumbar punctures are performed (according to strict indications). With an increase in intracranial pressure, dehydration therapy is required. With the development of reactive meningitis, antibiotic therapy is performed. The lack of effect of conservative treatment and the progression of hydrocephalus is an indication for shunting.

In order for a child born with such a pathology to fully develop in the future at the level of his peers, he should be provided with proper treatment and proper care, starting from the first days of life.