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Intracranial hemorrhage in newborns
Last reviewed: 23.04.2024
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Intracranial hemorrhage into the brain tissue or into surrounding tissues can occur in any newborn, but especially often develop in premature babies; About 20% of premature newborns with a birth weight less than 1500 g have intracranial hemorrhage.
Hypoxic ischemia, fluctuations in blood pressure and pressure exerted on the head during labor are the main reasons. The presence of a nucleated layer of the caudate nucleus (embryonic cells located above the caudate nucleus on the lateral wall of the lateral ventricles, which are found only in the fetus) makes the hemorrhage more likely. The risk also increases in the presence of hematological disorders (eg, vitamin K deficiency, hemophilia, disseminated intravascular coagulation syndrome - ICE).
Such birth trauma as intracranial hemorrhage in newborns can occur in several CNS spaces. Small hemorrhages in the subarachnoid space, sickle and nemetry of the cerebellum are often incidental findings on the autopsy of newborns that died from causes not related to the central nervous system. Large hemorrhages in the subarachnoid or subdural space, the parenchyma of the brain or the ventricles are less common, but they are more severe.
Subarachnoid hemorrhage is reliably the most frequent form of intracranial hemorrhage. Apnea, seizures, impaired consciousness, or neurologic disorders in newborns may occur. With large hemorrhages, concomitant inflammation of the pia mater can lead to the development of communicating hydrocephalus as the baby grows.
Subdural hemorrhage, which is less common now due to the improvement of obstetric care, develops as a result of rupture of the crescent of the dura mater, of the hints of the cerebellum or veins flowing into the transverse and upper sagittal sinuses. Such discontinuities tend to occur in newborns at first birth, in large newborns or after severe birth, these are conditions in which there is increased pressure on the intracranial vessels. The first manifestation may be convulsions; rapidly increasing dimensions of the head or neurological disorders - hypotension, a weak reflex of Moro or a common bleeding in the retina of the eye.
Intraventricular and / or cerebral hemorrhage usually occurs within the first 3 days of life and is the most severe form of intracranial hemorrhage. Hemorrhages most often occur in premature newborns, often bilateral and usually occur in the embryonic layer of the caudate nucleus. Most hemorrhages are subependymal or intragastric and small in volume. In case of large hemorrhages, it can mark hemorrhage to the parenchyma or ventricles of the brain with a large amount of blood in the large and basal cisterns. Hypoxia-ischemia often precedes intragastric and subarachnoid hemorrhage. Hypoxic ischemia leads to damage to the endothelium of the capillaries, disrupts cerebral vascular autoregulation, and can increase cerebral blood flow and venous pressure, each of which can make a hemorrhage more likely. Most intraventricular hemorrhages are asymptomatic, but large hemorrhages can cause apnea, cyanosis, or sudden collapse.
[Diagnosis of intracranial hemorrhage in newborns
Intracranial hemorrhage should be suspected in any newborn with apnea, seizures, impaired consciousness or neurological disorders.
It is necessary to appoint a CT of the head. Despite the fact that ultrasound of the brain is safe, does not require sedation and can easily detect blood in the ventricles or brain tissue, CT is more sensitive for detecting a small amount of blood in the subarachnoid or subdural space. If the diagnosis is uncertain, you can examine the cerebrospinal fluid to detect red blood cells: usually the cerebrospinal fluid contains blood. At the same time, a small amount of erythrocytes is often present in the CSF in term infants. With subdural hemorrhage, diaphanoscopy of the skull can reveal a diagnosis after the blood has been lysed.
In addition, a coagulogram, a generalized blood test and a biochemical blood test should be conducted to identify other causes of neurological dysfunction (eg, hypoglycemia, hypocalcemia, electrolyte disorders). EEG can help to establish a prognosis if a newborn child survives an acute period of hemorrhage.
Treatment of intracranial hemorrhage in newborns
In most cases, the treatment is supportive, in addition to hematological causes of hemorrhage. All children should receive vitamin K if they have not been administered before. According to the results of the study of the blood coagulation system, thrombomass or clotting factors are prescribed. Subdural hematomas should be treated by a neurosurgeon; may require removal of blood.
What prognosis does intracranial hemorrhage have in newborns?
With a subarachnoid hemorrhage, the prognosis is usually good. Subdural intracranial hemorrhage in newborns has a cautious prognosis, however some babies recover. Most infants with small intraventricular hemorrhages experience an acute period and then recover. For infants with large intraventricular hemorrhages, the forecast is unfavorable, especially if the hemorrhage spreads to the parenchyma. Many have neurological residual symptoms.