Cerebral hemorrhage in a newborn: causes, symptoms and treatment of premature babies. Subarchnoid hemorrhage in newborns What is the danger of cerebral hemorrhage in newborns

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 an intraventricular hemorrhage, which is very characteristic of the neonatal period and often accompanies the pathological course of childbirth.

Intraventricular hemorrhage also occurs in adults, representing one of the forms with high lethality. As a rule, blood thus enters the ventricular system from 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 unfavorable circumstances, but also a prognosis, which is far from always able to reassure young parents.

In addition to children born with an abnormal course of the birth period, IVH is diagnosed in premature babies, while 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 bleeding in the ventricles occurs in the first day of life, up to 25% of IVH occurs on the second day after birth. The older the child is, the less likely it is to have circulatory disorders in the brain, even if the course of labor is abnormal.

Today in the arsenal of neonatologists there are highly informative research methods that make it possible to diagnose intraventricular hemorrhage in a timely manner, but problems with the classification, determination of the stage of pathology have not yet been resolved. A unified classification of DRC has not been developed, but 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 hemorrhage in newborns

The reasons for the development 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:

• Prematurity condition;
• Long dry period;
• Severe in childbirth;
• Injuries with obstetric benefits (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 the main cause of intraventricular hemorrhage, which should gradually disappear as the fetal brain and vascular system matures. If childbirth occurred ahead of time, then the presence of this structure creates the prerequisites for IVH.

The germinal matrix is \u200b\u200ba region of neural tissue around the lateral ventricles that contains immature cells that move to the brain and become neurons or neuroglia cells when they mature. In addition to cells, this matrix contains unripe vessels of the capillary type, the walls of which are single-layered, therefore, they are very fragile and can rupture.

Hemorrhage into the germinal matrix is \u200b\u200bnot yet IVH, but it most often leads to the penetration of blood into the ventricles of the brain. A hematoma in the nerve tissue adjacent to the wall of the ventricle breaks through its lining, and blood rushes into the lumen. Since the appearance of even a minimal volume of blood in the ventricle of the brain, we can talk about the onset of an independent disease - intraventricular hemorrhage.

Determination of IVH stages 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 distribution towards the nervous tissue.

Radiologists base the determination of the IVH stage on the results of computed tomography. They distinguish:

• IVH of 1 degree - subependymal - blood accumulates under the lining of the ventricles of the brain, without destroying it and not getting into the ventricle. In fact, this phenomenon cannot be considered a typical IVH, but at any time, blood can break through into the ventricles.
• IVH of the 2nd degree is a typical intraventricular hemorrhage without expansion of its cavity, when there is a release of blood from the subependymal space. On ultrasound, this stage is characterized as IVH with filling less than half of the volume of the ventricle 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 traced on CT and ultrasound.
• IVH degree 4 is the most severe, accompanied not only by filling the ventricles of the brain with blood, but also spreading it 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.

On the basis of 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, not dilated, spontaneous cessation of bleeding and preservation of normal CSF dynamics are possible.
2. Continuation of filling of the lateral ventricles with their possible expansion, when at least one of the ventricles is more than 50% filled with blood, and the blood spreads to the 3rd and 4th ventricles of the brain occurs at 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. The likelihood of fatal complications is high.

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 flow of cerebrospinal fluid. In severely premature babies, as well as those who have undergone deep hypoxia, disorders of the blood coagulation system occur, therefore clots do not appear in the brain cavities for a long time, and liquid blood “spreads” freely through the brain regions.

At the heart of the disturbance of the circulation of the cerebrospinal fluid and the growth in the future lies the penetration of blood into the ventricle, where it mixes with the cerebrospinal fluid, but does not immediately fold. Part of the liquid blood penetrates into other brain cavities, but as it coagulates, clots begin to overlap the narrow zones through which the cerebrospinal fluid circulates. Overlapping of any of the openings of the brain entails blockage of the cerebrospinal fluid 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 occurs in the first three days of a baby's life, and the less 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 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 ependymus, signs of brain damage will appear closer to the year with phenomena.

Typical intracerebral hemorrhage manifests itself with symptoms such as:

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

The severity 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. A minimal IVH that does not cause obstruction of the cerebrospinal fluid and changes in the volume of the ventricles will be accompanied by an asymptomatic course, and it can be suspected by a decrease in the number in the baby's blood.

Jumping current observed with moderate and submassive IVH, which are characterized by:

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

Symptoms in a spasmodic course are expressed for several days, after which they gradually decrease. It is possible both a complete recovery of brain activity and minor deviations, but the prognosis is generally favorable.

Catastrophic course of IVH is associated with severe disorders of the brain and vital organs. Coma, respiratory arrest, generalized convulsions, cyanosis of the skin, bradycardia, decreased blood pressure, and disturbances in thermoregulation are characteristic. Intracranial hypertension is evidenced by the bulging of the large fontanelle, 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 evidenced by a drop in the hematocrit level, a decrease in calcium, fluctuations in blood sugar, often disorders of the gas composition of the blood (), electrolyte disturbances (acidosis).

To complications of IVH include blockade of the cerebrospinal fluid by blood clots with the development of acute occlusive hydrocephalus, atrophy of the cerebral cortex and impaired psycho-motor development. Impaired circulation of cerebrospinal fluid leads to an increase in the size of the ventricles, an increase and compression of the cerebral cortex, which already suffers from hypoxia. The result is convulsive syndrome, depression of consciousness and coma, cardiac arrest and respiratory arrest.

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, impaired sensitivity, 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 periventricular leukomalacia and cortex atrophy are noted. By about a year, developmental delay becomes noticeable, motor skills suffer, the child cannot walk and perform correct movements with his limbs in due time, does not speak, lags behind in mental development.

Diagnosis of IVH in babies 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 in the first days of life to undergo ultrasound.

IVH in a diagnostic image

Treatment and prognosis

Neurosurgeons and neonatologists are involved in the treatment of children with IVH. Conservative therapy is aimed at restoring the work of vital organs and blood parameters. If the child did not receive vitamin K at birth, then it must be administered. The deficiency of clotting factors and platelets is replenished by transfusion of plasma components. When breathing stops, artificial ventilation of the lungs is carried out, but it is better to establish it as planned, if there is a risk of respiratory disorders.

Drug therapy includes:

• Normalization of blood pressure to prevent a sharp decrease or surges, aggravating hypoxia and damage to the nervous tissue;
• Oxygen therapy;
• Anticonvulsants;
• Blood clotting control.

To reduce intracranial pressure, the introduction of magnesium sulfate is shown intravenously or intramuscularly, diacarb, furosemide, veroshpiron are used for term infants. Anticonvulsant therapy consists in the appointment of diazepam, valproic acid preparations. To relieve the symptoms of intoxication, infusion therapy is performed, acidosis (blood acidification) is eliminated by using an intravenous sodium bicarbonate solution.

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

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

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 moment 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.

ventricular drainage catheter insertion

If hydrocephalus has acquired a persistent and irreversible character, and the effect of fibrinolytic therapy is absent, then neurosurgeons provide permanent drainageoperatively:

1. Installation of permanent shunts with outflow of cerebrospinal fluid 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 is stabilized and hydrocephalus does not progress);
2. Endoscopic anastomoses between the ventricles of the brain and the basal cistern.

The most common method of surgical treatment of occlusive hydrocephalus against the background of IVH is considered ventriculoperitoneal drainage... It is affordable, allows the introduction of drugs into the ventricles, has a low probability of infection, can be carried out for a long time, while caring for a child is not accompanied by difficulties. The use of alteplase, which accelerates the dissolution of blood clots in the ventricles, allows reducing mortality and maximizing the functioning of the brain.

Forecast in IVH, it is determined by the stage of the disease, the volume of hemorrhage and the localization of damage to the brain tissue. At the first two degrees of IVH, the blood clots are absorbed either by themselves or under the action of treatment, without causing significant neurological disorders, therefore, with minor hemorrhages, the child can develop normally.

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

All children with intracranial hemorrhage are subject to close 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 follow the measures for preventing brain damage in newborns and very premature infants. Expectant mothers need to undergo the necessary preventive examinations and examinations in a timely manner, and in case of the threat of premature birth, the task of obstetricians-gynecologists is to prolong pregnancy as much as possible with medications until such time as the risk of hemorrhage becomes minimal.

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Traumatic brain injury often occurs in the perinatal period and is manifested by a disorder in the function of vital organs and systems. A cerebral hemorrhage occurs, which can seriously harm your baby's health.

What causes cerebral hemorrhage in newborns

Intracranial hemorrhages refer to hypoxic lesions of the central nervous system. The reasons for the development of chronic oxygen deficiency are:

• severe pregnancy;
• violation of the 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 trauma, they are accompanied by:

• swelling of tissues;
• violation of cerebral circulation;
• deterioration of respiratory and cardiac activity;
• rupture of the cerebellar tentorium.

Risk group and causes of hemorrhage in infants

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

The appearance of hemorrhages in the embryonic matrix is \u200b\u200bfacilitated 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:

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

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

• violation of blood clotting;
• acidosis;
• changes in metabolism.

The 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 hemorrhage

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

• etiology;
• clinical picture;
• morphology.

Epidural

With fractures or cracks in the bones of the skull in a newborn, epidural hemorrhage occurs 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.

Hemorrhages are of two types: punctate and spotted. The cause of the pathology is an anomaly of ossification of the skull.

Subdural

Hemorrhage is characterized by the following symptoms:

• location between the dura mater and arachnoid;
• bleeding;
• violation of hemodynamics.

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

• protracted labor;
• stiffness of the muscles of the pelvis of the woman in labor;
• the use of obstetric forceps and a vacuum extractor;
• breech presentation.

Subarachnoid

The classification of hemorrhages is determined by the following signs:

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

Often the reasons for the development of a blow are:

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

There are several types of hemorrhages:

• point;
• spotted;
• large focal.

A newborn develops the following symptoms:

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

The forecast depends on the type of blow.

Intracerebral and ventricular

Subendymal hemorrhage affects brain tissue.

Ventricular pathologies are divided into several types:

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

The causes of the 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;
• breathing disorder;
• tonic convulsions;
• paresis of the gaze;
• irregular heartbeat;
• acidosis.

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

In the absence of effective assistance, death is possible.

Symptoms of cerebral hemorrhage in newborns

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

For subarachnoid hemorrhage in newborns, there are 3 clinical syndromes:

1. minimal signs of the disease or their complete absence;
2. convulsions in term infants and attacks of respiratory distress in premature infants,
3. rapid deterioration in health and death.

A cerebral hemorrhage in a nursing newborn child often ends with a secondary lesion of the diseased organ.

If the lateral ventricles of the brain are completely filled with blood and the cerebellar hemispheres are damaged, the prognosis is unfavorable for the child.

Cerebral hemorrhage in newborns is manifested by symptoms such as:

• increased skin sensitivity;
• tension of the large fontanelle;
• gref's symptom;
• increased tendon reflexes;
• nystagmus.

The development of hemorrhage in premature babies is due to many reasons, and its complications and consequences manifest themselves as the following pathological conditions:

• hydrocephalus;
• compression of the brain stem;
• pneumonia.

The patient's health deteriorates catastrophically or abruptly as a result of hemorrhage in the ventricles of the brain.
In this case, the child is observed:

• sleep disturbance;
• paresis of the gaze;
• an increase in the large fontanelle;
• metabolic disorder;
• refusal to eat;
• weakness;
• lethargy;
• unconsciousness.

With a slow outpouring of blood, the following symptoms appear:

• lowering blood pressure;
• low body temperature;
• regurgitation;
• insufficient amount of calcium ions in the blood serum;
• lowering glucose levels.

In severe cases, the newborn develops progressive disorders of vital functions:

• breathing disorder;
• rare pulse;
• heart arythmy;
• convulsions;
• fatal outcome.

In a child with subarachnoid hemorrhage, headaches intensify, nausea, vomiting occur.

In some cases, meningeal symptoms appear:

• photophobia;
• limiting the movement of the eyeballs;
• kerning's and Bruzinsky's symptoms;
• neck muscle tension.

Often the patient has confusion.

In the early period of the disease, as a result of blockade by blood clots of the basal cisterns and 4 ventricles, the child is observed:

• drowsiness;
• violation of consciousness;
• gaze paralysis;
• visual pathology.

Diagnostics

During a CT scan, blood is found in the cerebrospinal fluid. Its concentration is high, hemorrhages are located in the lateral part of the subarachnoid space, less often in the area of \u200b\u200bthe basal nuclei. Angiography of the cerebral vessels establishes the cause of the stroke. It is performed in 3 projections: direct, lateral, oblique.

The diagnosis of intraventricular hemorrhage is made by conducting 2 types of research:

1. ultrasound scanning;
2. computed tomography.

On the first day after birth, a neurotrophic factor is determined, which is a biochemical indicator of intraventricular hemorrhage.

In the event of a severe pathology, the patient is recommended:

• ventricular puncture;
• external drainage;
• implantation of subcutaneous ventricular catheters;
• shunting;
• the introduction of fibrinolytic drugs;
• lavage with artificial liquor.

In the early diagnosis of intracranial hemorrhage, neurosonography, US monitoring, magnetic resonance imaging, CT are used.

Treatment

Therapy is carried out according to the doctor's prescription, using the fight against intracranial pressure, elimination of hypotension or hypertension, restoration of the circulatory system, elimination of the toxic effect of the decay products of cells and tissues.

The child is prescribed a 25% solution of magnesium sulfate intravenously in a stream, Diakarb, Lasix or Veroshpiron with diuretic intolerance. Surgical therapy is recommended.

Conservative treatment is carried out with asymptomatic subarachnoid hemorrhages.

The doctor chooses one of 3 methods to eliminate hematoma:

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

A craniotomy is performed when blood clots form. Puncture elimination is used in the 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 performed for respiratory disorders caused by cerebral hemorrhage. For treatment, the drug Kurosurf is used. 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. the study of heart rate indicators;
2. heart rate monitoring;
3. cO₂ control by capnography.

In the event 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 urine output.

For resuscitation measures use:

• hemostatics;
• dehydration therapy;
• broad-spectrum antibiotics;
• sedatives;
• pain relievers.

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

With central vascular spasm, the following are prescribed:

• vasodilators;
• 25% magnesium sulfate solution.

For sedation, the patient is recommended:

• Propofol;
• drugs of the benzodiazepine series.

In case of coma, emergency therapy is indicated:

• restoration of spontaneous breathing;
• fight against hypoglycemia.

Rehabilitation

The 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 undergoes a rehabilitation course. It includes the correction of neuropsychiatric and somatic disorders and drug and non-drug treatment.

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

• physical activity;
• excitation;
• muscle hypertension;
• violation of motor function.

Rehabilitation measures allow you to eliminate impaired attention, difficulty of 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;
• antipsychotics;
• nootropic drugs.

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

Forecast for later life

The course and outcome of the disease are influenced by:

• localization of hemorrhage;
• the age of the child.

Against the background of small hemorrhages, most newborns show a rapid recovery of lost functions. With moderate lesions, the child often develops post-traumatic epilepsy.

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

Cerebral hemorrhage in newborns is a serious pathology that develops as a result of damage to the vessels of the dura mater or rupture of a cerebral vessel. This often happens with birth injuries. According to statistics, intracranial hemorrhage (intracranial hemorrhage) occurs in 1 out of 1000 cases in full-term infants. However, deeply premature babies born with a body weight of 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 complications such as neurological pathologies, hydrocephalus, cerebral palsy, cerebral edema, visual impairment, 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 infant and the compensatory abilities of the brain.

Causes

As we have already found out, deeply premature infants or term infants with a history of intrauterine growth retardation are most at risk of developing pathology.

One of the first reasons can be considered chronic fetal hypoxia at 26-34 weeks of gestation. The fact is that during this period the periventricular space is literally penetrated by a large number of vessels that play an important role at this stage, but eventually cease to carry functionality. If complications occur and there is a 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);
• pathology against the background of severe hypoxia: acidosis, too strong activation of fat peroxidation, low blood pressure;
• intrauterine infection with viruses, mycoplasmas, which contribute to the destruction of the walls of blood vessels;
• chronic diseases of the mother (for example, diabetes mellitus);
• the influence of a woman's addictions (tobacco smoking, alcoholism);
• trauma during childbirth due to the narrow birth canal and the large head of the fetus, during rapid childbirth, cesarean section;
• 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, that deliver oxygen to it and protect the brain center from germs and viruses. The top of the skull is covered with a hard shell, called "dura mater" in Latin. If the hemorrhage occurs under this membrane, it is called subdural, if between the membrane and the skull, then epidural.

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

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

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

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

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

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

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

Signs of a cerebral hemorrhage do not always appear immediately. Pathology can be asymptomatic for the first day.

Symptoms

The clinical picture, depending on the localization of vascular lesions, will be slightly different, but in general, characteristic signs of hemorrhage in infants are highlighted:

• a sharp deterioration in the condition, symptoms of hyperexcitability are replaced by signs of depression;
• the fontanelle swells strongly, is in tension;
• the strength and nature of the baby's cry changes;
• convulsive activity;
• peripheral circulatory disorders, heart palpitations, frequent regurgitation, weight loss, increased gas production, shortness of breath, apnea;
• anemic syndrome, a 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 failure;
• the addition of a secondary infection, as a result of which the development of sepsis, meningitis, pneumonia is possible.

Now we will characterize the clinical picture in individual situations:

SEC

One of the most common forms of hemorrhage. SEC does not have any special specific symptoms. Its most important manifestation is considered to be repeated attacks of apnea in the first days of a newborn's life. The diagnosis is made only after neurosonography.

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

Intraventricular hemorrhage in newborns

With hemorrhage in the cerebral ventricles of 1 and 2 degrees of severity, there are no visible symptoms and can pass without the development of neurological pathologies. However, in more severe cases, there are swelling of the fontanelles, convulsions, disruptions in the work of breathing and the cardiovascular system. Then comes lethargy, reflexes and physical activity are inhibited, the head can 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 practically the same, so that 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 excitement / oppression alternate. Even with the development of seizures in between, the child looks completely healthy. The prognosis and the need for treatment, again, will depend on the degree of damage.

Diagnostics and treatment

The diagnosis is made on the basis of the results of ultrasound examination through the fontanelle 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 cerebral edema. At the same time, it is necessary to maintain cerebral blood flow.

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

If this treatment does not give results, surgery is indicated: bypass surgery.

Separately, I would like to say about adrenal hemorrhage in newborns. With a severe form of hypoxia or improper management of childbirth, adrenal hemorrhages are possible, which, if not treated in time, lead to death. When 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 to be safe from all diseases. Therefore, in this situation, prevention comes down to taking a responsible attitude towards your pregnancy, being examined by a gynecologist on time and, if necessary, treated. It is in our power to choose a maternity hospital and a doctor for childbirth, whom we trust. But the delivery process is sometimes so unpredictable that you don't know what complications may arise. Therefore, it is also important for parents to remain calm, not to cheat themselves, and after the birth of the baby, provide him with proper care.

Hemorrhage in the brain of a newborn is one of the most difficult birth injuries affecting the central nervous system. In a similar state, the child's skull is damaged, as a result of which a blood vessel in the brain ruptures.

Features and risk factors

There are many factors that can provoke intracranial bleeding. This is due to both pathological pregnancy and the banal negligence of doctors. In this case, the vessel can burst in any area of \u200b\u200bthe child's brain.

The causes of hemorrhage in babies largely depend on the date at which they were born. Most often, this 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 protracted labor, which is considered pathological and causes cerebral hypoxia in the fetus.
3. Using forceps that will damage the baby's skull.
4. Postterm pregnancy. In this condition, the baby's skull bones lose their elasticity, increasing the risk of injury during childbirth.
5. Intrauterine infection.
6. Too large fetus in a woman with a narrow pelvis.
7. Various defects in children.

Remember! In premature babies, the risk of injury during childbirth with further intracranial hemorrhage is 50%. The highest probability of pathology in this case is in babies weighing less than 1.5 kg.

Types and symptoms of cerebral hemorrhage

Common signs of cerebral hemorrhage in children are:

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

Additional symptoms may appear 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 when using auxiliary manipulations during childbirth. In this state, vascular damage is observed over the substance of the brain, which leads to strabismus, constant screaming, convulsions, and disturbed sleep.
2. Epidural view. This pathology leads to damage to the vessels that are located under the bones of the skull. A complication develops during post-term pregnancy or rapid childbirth. Symptoms of this hemorrhage include low blood pressure, seizures, 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 most dangerous is the period of the first week after the birth of the child, when the initial symptoms of hemorrhage are detected. If no deterioration is 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 due to the characteristic manifestations of the disease. To clarify the diagnosis, the baby should conduct several important studies.

Initially, CT diagnostics are prescribed. This is the most accurate method and is very informative for brain damage. He will not only reveal the focus of pathology, but also be able to detect the type of hemorrhage.

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

Confirmation of the diagnosis requires urgent hospitalization and treatment.

Treatment

Treatment of cerebral hemorrhage in children depends on the degree of neglect (1, 2 or 3 degrees) and the type of pathology. In this case, a specific course of treatment is selected by the attending physician individually for each individual baby. In this case, the doctor must take into account the neglect of the condition, the symptoms and 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, Vikasol or calcium Chloride preparations are prescribed.
To restore important trace elements in the body, the course of treatment includes Glucose, Sodium Sulfate, Panangin.

To help a child, parents should look to the following advice:

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

Possible complications

The brain of babies has excellent recovery abilities, therefore, with minor 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 a similar state, 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 disappear without a trace in a child. If the baby has 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, the crib should be positioned so that the head end is slightly raised. Ice is placed 30 cm from the patient's head. A heating pad is placed near the feet.

In the first week, the newborn should be fed with breast milk. If the swallowing function is impaired, 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 they get older, your child may need swimming and lessons with a speech therapist.

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 should be monitored periodically by a doctor.
2. Monitor your health and avoid stress.
3. Refuse hard physical work that 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 make sure of proper nutrition.
6. Carefully approach the choice of clinics and the doctor who will deliver the baby.

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 cesarean section. This will protect against unwanted consequences.

A cerebral hemorrhage in a newborn is considered a very dangerous pathology, which must be responded to immediately. Even if, after leaving the hospital, parents notice signs of brain damage, you should consult a doctor as soon as possible in order to be able to prevent serious complications.

Among the causes of cerebral hemorrhage in newborns, birth trauma and genetic abnormalities come to the fore. An important feature of infant hemorrhages is the high risk of mortality due to the general vulnerability of the infant's immunity.

Cerebral hemorrhage in the subarachnoid fissures occurs due to:

• rupture of an aneurysm of the intracranial artery,
• rupture of arteriovenous milformation.

A rupture of the walls of the intracranial artery can also provoke a cerebral hemorrhage. This can happen for various reasons:

• atypical immune and genetic disorders,
• head injuries and bruises,
• traumatic brain injury (they can be provoked by problems of delivery, injury to the crumbs),
• smoking parents,
• the use of drugs and alcohol by the mother during pregnancy,
• persistent high blood pressure
• infections that damage the brain.

Symptoms

At the moment of the very hemorrhage, the child feels a severe headache. Moreover, it can continue for a very long time - until the cause is identified and eliminated. In babies, the signal of pain is constant whims and crying for no apparent reason.

The following symptoms are also characteristic of hemorrhage:

• phonophobia or photophobia (painful reaction and lacrimation under any light source),
• constant nausea, even bouts of vomiting do not relieve the condition,
• dizziness and fainting
• seizures (often of the whole body) temporary squint,
• decrease or increase in the sensitivity of skin receptors,
• erratic increased psychomotor activity.

Diagnosis of subarachnoid hemorrhage in a newborn

To make an accurate diagnosis, determine the causes of the disease and its severity, the doctor needs to carry out extensive diagnostic activities, including:

• study of the history and complaints of parents,
• blood pressure measurement,
• visual inspection,
• neurological examination
• , general and clinical analysis of blood and urine,
• lumbar puncture for examining the cerebrospinal fluid and cerebrospinal fluid,
• magnetic resonance imaging and computed tomography of the head,
• ECHO encephalography,
• transcarnial doppler - research,
• magnetic resonance angiography.

Complications

Due to the lack of timely diagnosis and adequate treatment, as well as due to severe hemorrhage, the following consequences are possible:

• uncorrected neurological defects - speech problems, strabismus, increased muscle tone, muscle atrophy, disability, cerebral infarction, sepsis,
• cosmetic defects,
• mental and physical retardation, problems with adaptation in the children's team, difficulties in socialization in adult life,
• lethal outcome - occurs most often in infants.

Treatment

What can you do

In no case do not leave “unreasonable” crying and whims without attention. This can be very dangerous for your baby's health and life.

To treat and prevent consequences, parents should:

• agree to hospitalization of the child,
• fulfill all the appointments of the attending physician,
• take care of the baby (carry out hygiene procedures, feed, carry out feasible gymnastics and physical education),
• refuse self-medication and the use of traditional medicine methods,
• maintain emotional peace in the family,
• minimize the child's physical activity,
• keep breastfeeding as long as possible.

What the doctor does

Hemorrhage must be treated very quickly. In order to restore the body and prevent complications caused by subarachnoid hemorrhage, the following therapeutic procedures are performed:

• hospitalization of a small patient and immediate treatment in the neurosurgical department,
• prescribing drugs that restore blood clotting,
• medicated lowering of blood pressure,
• taking calcium channel blockers to reduce spasms of intracranial arteries,
• the use of neuroprotectors and neurotrophics for the speedy normalization of the state of the nervous tissue,
• rehabilitation therapy (therapeutic and recreational physical education, speech therapy classes to restore speech,
• removal of blood accumulated in the subarachnoid space (performed by various surgical methods, depending on the location and extent of the hemorrhage).

Prevention

There are no special measures to prevent hemorrhage. It is important to minimize the impact of provoking factors:

• minimize the risks of injury (carefully carry and shift the baby, minimize the risks of any falls and bruises, prepare for childbirth),
• quit smoking to strengthen the immune system (breastfeeding, hardening, vitaminization, daily routine, regular exercise, a good night's sleep, daily walks in the fresh air),
• timely treat all infectious diseases and prevent their development,
• regularly undergo medical examinations,
• if signs appear, contact a specialist without delay.