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

IVH is often diagnosed in premature infants due to their physiological features. The shorter the gestational age, the higher the likelihood of hemorrhage.

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

Who is at risk?

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

Prerequisites for VZhK:

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

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

The risk of cerebral hemorrhage in a child increases with:

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

Characteristic symptoms

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

The most common symptoms of intraventricular hemorrhage in infants are:

• decrease or disappearance of the Moro reflex (to external stimuli);
• decreased muscle tone;
• sleepy state;
• episodes of apnea (stopping breathing);
• skin pallor, cyanosis;
• refusal of food, weakness of sucking reflexes;
• oculomotor disorders;
• weak and piercing cry;
• muscle twitching, convulsions;
• paresis;
• metabolic acidosis(acid-base balance is disturbed);
• decrease in hematocrit or lack of its increase against the background of blood transfusion;
• a large fontanel is tense and bulges;
• coma (with severe hemorrhages, as well as concomitant hemorrhages in the cerebral cortex, significant stretching of the ventricles).

Severity

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

1. IVH 1 and 2 degrees. Hemorrhage is observed in the projection of the germinal matrix and does not extend into the lumen of the lateral ventricles. In the second stage, the hemorrhage is slightly larger (>1 cm) than in the first.
2. At grade 3, hemorrhage from the germinal matrix enters the lumen of the lateral ventricles. As a result, posthemorrhagic ventriculomegaly or hydrocephalus develops. On the tomogram and section, there is an expansion of the ventricles, in which blood elements are clearly visible.
3. Grade 4 is the most severe, there is a breakthrough of IVH into the periventricular parenchyma. Hemorrhage is observed not only in the lateral ventricles, but also in the substance of the brain.

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

Diagnostic methods and criteria

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

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

Possibilities of modern medicine

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

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

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

1. Ventricular (through the fontanel) or lumbar (through the lower back) puncture.
2. Ventriculoperitoneal shunting, when a special drainage tube is inserted into the ventricles. It extends under the skin abdominal cavity patient where excess CSF is absorbed. drainage system should be constantly in the body, and the tube is replaced if necessary.

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

Prognosis depending on the degree of hemorrhage

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

1. Grade 1 and 2 hemorrhages often do not require any treatment. These infants need to be monitored and there is little chance that any neurological abnormalities will develop. Cases of development of hydrocephalus and death at 1 and even 2 degrees of violation are extremely rare.
2. 3 degree. With a breakthrough hemorrhage in the ventricles, the likelihood of developing hydrocephalus increases, it can occur in about 55 percent of cases. Neurological abnormalities are observed in 35%. A lethal outcome occurs on average in every fifth child. Surgery is indicated for patients, and the outcome depends on the extent of brain damage, on the location (the prognosis is more favorable if IVH is present within only one lobe, especially only in the frontal lobe).
3. 4 degree. Unfortunately, the prognosis for such a severe pathology is disappointing. Surgical intervention in this case is inevitable, while the risks of death remain high - about half of infants with IVH of the 4th degree die. In 80% of cases, hydrocephalus develops, in 90% - neurological abnormalities.

Preventive measures

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

Correct definition of tactics of delivery

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

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

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

Prenatal screening

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

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

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

IVH of the newborn

Intraventricular hemorrhage (IVH) is one of the most common ailments that occur at birth in premature babies. Babies born prematurely have incompletely formed blood vessels in the brain. Due to their vulnerability, the thinnest walls of blood vessels are subject to the slightest pressure fluctuations. Due to hypoxia and birth trauma, immature vessels rupture, blood flows into various parts of the ventricles in the brain, forming IVH.

Despite the rather frequent occurrence of this problem in premature babies, IVH can also develop in newborns with normal weight. A change in pressure in the brain can develop due to hypoxia during childbirth, the presence of infections in the mother, mechanical injuries. All these factors may well provoke the development of IVH in term infants. razvitierebenca.ru

We highlight the main factors that increase the risk of developing IVH:

• infectious diseases in the mother, leading to impaired blood clotting;
• respiratory failure during childbirth;
• prolonged or rapid childbirth;
• lack of vitamin K, disturbing blood clotting;
• mechanical impact on the fetus (when applying forceps or applying a vacuum).

IVH severity

Depending on the localization of the spread of hemorrhage, IVH is divided into 4 degrees of severity.

At the I degree, the blood affects only the walls of the ventricles;

At II degree, blood penetrates into the cavity;

At the III degree there is an extensive hemorrhage, leading to the expansion of the lateral ventricles. This process can lead to hydrocephalus.

In the IV degree, blood enters the brain tissue, affecting it.

IVH symptoms in newborns

IVH I and II degree may be asymptomatic. Much more dangerous is the development of IVH of III and IV degrees. In such cases, fluid can accumulate in the ventricles of the brain, which can cause the development of dropsy, hydrocephalus, and brain atrophy.

The main signs indicating the possible presence of IVH:

• swelling of the fontanelles in the upper part of the head;
• weak sucking reflex;
• respiratory failure;
• lethargy, apathy;
• increased muscle tone;
• muscle spasms.

It is impossible to make this diagnosis on your own. There are many diseases that have similar symptoms with IVH, so it is better to leave the diagnosis to a specialist. Even in the hospital, the baby will be examined by a neonatologist. In the absence of visible signs, the child will still remain under observation for several days.

In many maternity hospitals, ultrasound of all newborns is practiced today. Do not refuse this procedure, even if you were not directed to it. With the help of ultrasound, the doctor will check the abdominal organs and the head of the baby. The slightest deviations from the norm will help buy time, and not start the treatment of those diseases that are not visible visually.

If the doctor sent the child for an ultrasound, there is a risk of rupture blood vessels. In this case, the diagnosis should be immediate.

In parallel, tests may be prescribed to detect anemia and infections. Child development.ru

IVH treatment

As such, IVH is not treated, because it is not a disease, but a process that provokes the development of complications in the activity of the brain.

When IVH is detected, its degree is first assessed. In the presence of І and ІІ degrees, the child's condition is monitored. If it remains stable, drugs are prescribed to eliminate the effects of hemorrhage. For example, anticonvulsant therapy, correction of anemia.

In grades III and IV, a neurosurgical operation may be required. For example, with hydrocephalus, shunting of the ventricles of the brain is prescribed.

Premature babies need to be provided with a strict protected regime, similar to intrauterine conditions. For this, the child is placed in a special incubator until the condition stabilizes.

The development of complications directly depends on the degree of damage to the ventricles. Hemorrhages of I and II degrees may not cause neurological pathology at all, while extensive hemorrhages of III and IV degrees can lead to disability and even death.

When the ventricular cavity expands, urgent bypass surgery may be required. Untimely detection and operation in case of extensive hemorrhage can lead to a violation of the development of motor functions, the development of child cerebral palsy, general developmental delay. Often IVH is the cause of future neuropsychological problems. In rare cases, there are problems with hearing and vision, up to blindness and deafness.

Prevention of IVH

It is rather difficult to prevent the development of IVH, since this process occurs spontaneously and is not subject to control. However, there are some steps you can take to reduce your risk of developing IVH.

1. During pregnancy, you must regularly visit a doctor, take all the prescribed tests. Even the simplest clinical blood test will help to identify the slightest deviations in early stages and prevent their further development in time.
2. Consult your doctor. If there is a risk of having a baby prematurely, the doctor will select drugs that reduce the risk of hemorrhage.
3. In the third trimester of pregnancy, undergo a preventive examination, at which the doctor will assess the ratio of the size of the fetus's head to the mother's pelvis. This will help determine the tactics of delivery, significantly reducing the likelihood of developing IVH.
4. During pregnancy, follow the regime, keep healthy lifestyle life, do not abuse the liquid, especially in the third trimester. Any fluctuations in blood pressure are a reason to consult a doctor.
5. If you're not intolerant of heat, try to minimize prolonged sun exposure. Temperature fluctuations negatively affect the vessels, and are by no means useful to the unborn child.

Remember that the successful outcome of childbirth is planning pregnancy in advance.

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

The germinal matrix is ​​a region of nervous tissue around the lateral ventricles containing immature cells that migrate to the brain and become neurons or neuroglia when they mature. 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 content, 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 current 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 through 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 the volume of the ventricles, will be accompanied by an asymptomatic course, and it can be suspected by a decrease in the hematocrit 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. O intracranial hypertension testifies to the bulging of a large fontanel, 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, and disorders are not uncommon. gas composition blood (hypoxemia), electrolyte disturbances (acidosis).

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, gliosis are noted. white matter, atrophy of the cortex. 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 carry out ultrasonography.

IVH on a diagnostic image

Treatment and prognosis

Children with IVH are treated by neurosurgeons and neonatologists. Conservative therapy It is aimed at restoring the work 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 lungs, 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 the 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, while caring for a 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 the 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 medications until such a time when the risk of hemorrhage becomes minimal.

If the child is still born prematurely, then he is placed in the intensive care unit for observation and treatment. Modern methods diagnostics 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.

The birth of a child is a rather unpredictable process and often the health of the baby suffers as a result. Of particular danger to the health of the baby are brain damage resulting from and. Oxygen starvation of the brain can lead to the occurrence of IVH in newborns - intraventricular hemorrhage. The risk of such a complication lies in wait mainly for children who were born prematurely. This is due to the immaturity of the vessels and structural features of the brain in this group of newborns. Premature babies have a special structure in the brain - the germinal matrix, the cells of which subsequently form the framework of the brain, migrating to the cortex. Intraventricular hemorrhage in newborns occurs as a result of rupture of the germinal matrix vessels and blood flow into the lateral ventricles. As a result of IVH, the migration of germinal matrix cells occurs with disturbances, which adversely affects the development of the child, causing delays.

IVH degrees

1. IVH 1 degree - hemorrhage is limited to the wall of the ventricles, not spreading to their cavity.
2. IVH 2 degrees - hemorrhage penetrates into the cavity of the ventricles.
3. IVH of the 3rd degree - there are violations in the circulation of the cerebrospinal fluid causing hydrocephalus.
4. IVH grade 4 - hemorrhage extends to the brain tissue.

IVH of 1 and 2 severity in newborns are usually asymptomatic, and they can be detected only with the help of an examination additional methods(computed tomography, neurosonography).

Consequences of IVH

The consequences of IVH for the health of the newborn depend on many factors, in particular, the severity of the hemorrhage, the gestational age of the baby, the presence of developmental pathology and concomitant diseases. IVH 1 and 2 degrees in newborns in 90% of cases resolve without a trace, without causing serious harm to the health of the child. IVH of grades 3 and 4 causes motor impairment and neuropsychological problems.

IVH (intraventricular hemorrhage) of the brain is a pathology of a neurological nature, which quite often occurs in newborn babies.

The etiology of this disease is, first of all, the pathological intrauterine development of the child and complications of the birth process.

What is IVH of the brain?

IVH also occurs in adults and is a type of stroke that is almost 100.0% fatal. Blood in this type of stroke enters the cerebral ventricular chamber system from blood hematomas inside the brain.

In a stroke, the intracerebral arteries rupture, leading to hematomas.

Intraventricular hemorrhages (IVH) in newborns occur in isolation. IVH is not associated with hematomas of the parenchymal type, and therefore can be classified as an independent pathology.

Intraventricular hemorrhage (IVH) is one of the most common diseases in infancy in children who were born prematurely.

The cause of pathology in premature babies is an incompletely formed system of intracranial vessels.

Underformed vessels are endangered even with the slightest variability in the blood pressure index in the circulatory system.

The reason for the rupture of the fragile walls of the arteries may be brain hypoxia, or head trauma during the passage of the birth canal by the child. Blood at a rupture of arteries gets to various chambers of departments of a brain and IVH is formed.

Importance of the IVH problem

The importance of IVH pathology in newborn babies is due to a rather complex diagnostic study of the pathology, as well as its drug treatment. After all, many drugs for the treatment of hemorrhage are not suitable for therapy in the newborn.

Time also plays an important role in solving the problem, because the nerve centers of the baby are not yet sufficiently adapted to stress, so they simply cannot endure a negative situation.

In addition to children who were injured during the birth process, IVH pathology is often diagnosed in children born prematurely.

And the shorter the period of intrauterine development of the baby, the higher the percentage of intraventricular hemorrhages.

In this situation, the complexity of cerebral hypoxia increases with a shorter period of intrauterine formation.

According to statistics:

• 50.0.0% of premature babies suffer from hemorrhage in the ventricles of the brain in 1 day after birth;
• In 25.0% of infants, the outpouring of blood into the chambers of the cerebral ventricles occurs on the 2nd calendar day from the moment of birth.

If a child is born on time, then even with deviations from the normative course of the birth process, the probability of ventricular IVH hemorrhage does not exceed 5.0%.

Etiology of IVH in newborn babies

The causes of hemorrhage in newborn babies are completely different from the causes that provoke a stroke in the adult population.

Causes of stroke in adults:

• Arterial hypertension (hypertensive crisis);
• Atherosclerosis of large diameter arteries;
• Cardiac ischemia;
• coronary insufficiency;
• thrombosis of arteries;
• Stenosis of cerebral vessels.

In adults with a stroke, a hematoma occurs inside the brain, and blood entering the chambers of the ventricles is already a secondary manifestation of a stroke.

In infancy, a stroke (intracerebral hemorrhage) occurs immediately in the ventricular chambers.

The main causes of what is happening in the children's brain are directly related with the course of pregnancy and with childbirth:

• premature baby;
• Hypoxia from a long period of the child's stay in the womb after the amniotic fluid has passed;
• Hypoxia of the brain during the passage of the baby through the birth canal of the mother;
• Injury to the baby during obstetric care during childbirth;
• Small birth weight of a child - less than one kilogram;
• Pathologies of coagulation of blood plasma, congenital genetic hereditary nature.

In children born at preterm age, the presence of the germinal matrix in such children is considered the main cause of IVH.

This matrix disappears from the brain regions during the maturation of the organ and the final formation of the intracranial vascular system.

The germinal matrix is ​​the main risk factor for IVH.

Germinal type of matrix

The germinal matrix is ​​the tissue cells of the organ that are located around the ventricles. This matrix contains immature cells, which, when they enter the brain regions, turn into neurons, or cells of neuroglia molecules, upon further maturation.

In addition to these immature cells, the matrix also includes immature vessels that have a very weak membrane, which, at the slightest deviation from the norm of the blood pressure index, can burst and provoke blood to enter the newborn's brain.

Hemorrhage into the cells of the germinal matrix is ​​not yet an IVH pathology, but this type of hemorrhage leads to the fact that blood enters the chambers of the ventricles of the brain.

A hematoma may form near the ventricular wall and blood will begin to seep into the spatial ventricular lumen.

When a minimum volume of biological fluid enters the ventricles, it is possible to state an independent type of disease - IVH.

The stages of IVH pathology indicate the severity of the disease, and also determines the type of therapy and the prognosis for the possibility of a cure.

IVH degrees according to the CT method

According to the results of the interpretation of the computed tomography technique, 4 degrees of development of IVH pathology were identified:

• 1 degree subependymal hematoma. Blood collects under the lining of the ventricular chambers of the brain. The fluid does not enter the ventricles, and do not destroy the state of the brain space. The danger of a breakthrough of the subependymal membrane and intracerebral outpouring of blood exists constantly;
• 2 degree is a typical intraventricular hemorrhage without an enlarged organ cavity. The filled subependymal space releases blood into the cavity of the ventricular chambers. The ventricles are filled with biological fluid by half their volume;
• 3 degree- this is the entry of blood into the ventricles and filling them by more than half, and in this situation the intraventricular chamber expands;
• Degree 4 premature babies is the degree of the most severe course diseases. At this degree, the ventricles are completely filled with blood, and the biological fluid enters the tissues of the nerve endings. Parenchymal hemorrhage begins inside the brain.

IVH stages according to brain damage

According to the results of a tomographic study, changes in the structure of brain cells are visible, and Based on these indicators, 3 stages of destruction of brain cells are distinguished:

• 1 stage organ damage. The ventricles are less than half filled with biological fluid, there is an option to stop bleeding on their own, the chambers are not expanded. There is a possibility of normal operation of the liquorodynamics of the organ;
• 2 stage filling the lateral ventricles with blood, their expansion occurs. The lateral ventricles are more than half full of biological fluid and the blood proceeds to fill ventricles #3 and #4;
• 3 stage pathology This is the most severe stage of damage to brain cells. Blood enters under the protective membrane of the cerebellum, an organ medulla and also in the cells of the spinal cord. More than 90.0% of cases of this pathology are fatal.

Violation in the proper circulation of cerebrospinal fluid (CSF) and the development of hydrocephalus occurs due to blood entering the cerebral ventricle, in which it mixes with cerebrospinal fluid and does not immediately clotting.

Partial volume of blood penetrates into other organs of the brain. The coagulation process begins in the blood, and blood clots close the channels for the normal passage of cerebrospinal fluid (CSF).

The blockade of the CSF passage path entails the expansion of the cavities of the cerebral ventricles and the pathology of hydrocephalus with its characteristic pronounced symptoms.

IVH symptoms

Up to 90% of all outpourings of blood in the brain occur in the first 3 calendar days after birth. The likelihood of hemorrhage in premature babies directly depends on the weight of the child - the greater his weight, the less likely it is to develop IVH.

After 7 calendar days, the risk of IVH decreases, which is due to the adaptation of the arterial system of the brain to the external environment, and the maturation of the germ cell type matrix is ​​currently taking place.

Premature babies after the first 3 days should be under the close attention of neonatologists in order to avoid IVH.

Pathology of the first degree passes without visible symptoms. The second degree of pathology also quite often passes without visible symptoms.

The third and fourth degree is a dangerous course of the disease, which can provoke such complications:

• dropsy of the brain;
• Hydrocephalus:
• Encephaly;
• Atrophy of brain cells.

Symptoms of IVH may not always be characteristic features intraventricular hemorrhage, and may also express other comorbidities.

The most common symptoms of IVH are:

• The reflex to external stimuli disappears (reduced or completely absent Moro reflex);
• Muscle tone is significantly reduced;
• Drowsiness;
• Apnea attacks - attacks of respiratory arrest, which immediately resume;
• cyanosis of the skin;
• The skin is pale;
• The sucking reflex is very weak, or completely absent;
• Refusal to eat;
• The function of vision is impaired (the child practically does not drive his eyes, but looks at one point);
• The cry is very weak;
• Muscle cramps;
• Paresis;
• Acidosis (there was an imbalance of the acidic environment in the body and alkaline);
• Impaired hematocrit;
• Blood transfusion develops;
• The fontanel is enlarged and constantly swells;
• Coma with hemorrhagic hemorrhages;
• The state of coma with greatly stretched cerebral ventricles, even if the ingress of biological fluid into the cerebral cortex did not occur.

The mildest stage of the pathology does not block the passage of cerebrospinal fluid (CSF), the size of the chambers of the cerebral ventricles does not change, and the course of this type of hemorrhage can only be determined by the result of a clinical biochemistry analysis - hematocrit.

In decoding, hematocrit values ​​are reduced.

When there is periventricular bleeding into the brain, the child has the following symptoms in the body:

• Suppressed emotional state (the child does not respond to external stimuli and bright light);
• Weakness of muscle tone;
• Paresis;
• Disturbances in the nerve endings of the eye organ - strabismus develops, as well as nystagmus;
• Disturbances in the respiratory system (there are signs of heavy breathing, as well as temporary apnea).

With a spasmodic type of disease, the symptoms appear for only a couple of days, and then there is a gradual subsidence of the symptoms. This is a consequence of the restoration of the functionality of the brain organs, or, on the contrary, a deviation in the performance of brain cells.

Deviations in this type of pathology are minor, which does not drastically affect the life prognosis.

Diagnostics

The pathology of IVH cannot be independently diagnosed and diagnosed. There are many diseases that exhibit this or similar symptoms. Therefore, an instrumental diagnostic examination of the cerebral arteries and their interpretation is prescribed by a neonatologist, as well as an ultrasound examination of all abdominal organs.

At timely diagnosis, you can start drug treatment pathologies of organs that are not visible visually, but identified during instrumental examination of the body.

With weak vessels in the brain, ultrasound just needs to be done immediately after birth in order to avoid an advanced stage of ventricular hemorrhage.

Also, in addition to the instrumental type of diagnostics, clinical testing of blood composition for the presence of anemia and inflammatory processes in the internal organs.

Treatment

IVH is quite difficult to treat, because this pathology is not a disease, and IVH is a process in the brain that provokes quite serious complications and serious consequences.

In the first degree of hemorrhage and in the second degree of the disease - constant monitoring of the pathology.

If the state of the brain is in a stable development of pathology, then drug therapy is used to eliminate the consequences of bleeding inside the cerebral ventricles.

When the first and second degrees of hemorrhage occur, there is no destruction of brain cells, abnormalities in the brain occur extremely rarely, and with 1st degree of consequences, and with 2nd degree of complications, they occur very rarely.

In the treatment of such children, they are provided with all the conditions close to intrauterine interruption:

• Air circulation;
• The temperature regime is like a mother's womb;
• Required air humidity;
• Light indicators.

These conditions can be provided by a special pressure chamber, in which the baby is until the state stabilizes after a brain hemorrhage.

The course of drug therapy medicines includes:

• Preparations for stabilizing the blood pressure index, in order to avoid the consequences of its sharp drop - hypoxia of brain cells, as well as hypoxia of nerve fibers;
• Method of oxygen therapy;
• Anticonvulsant drugs;
• Preparations for the normalization of blood coagulation - coagulants, anticoagulants.

To lower the pressure in the arteries of the intracranial box, intravenous preparations are used orally, as well as intramuscular:

Therapy with anticonvulsants:

• Medication Diazepam;
• Valproic acid.

An infusion is also carried out to cleanse the body of intoxication, and an intravenous injection of sodium bicarbonate is used to relieve the symptoms of acidosis.

For the treatment of a more complex stage of IVH disease, the following methods of surgical intervention are used:

• Ventricular puncture (via fontanel);
• Puncture of the lumbar type (through the lumbar region);
• CSF filtration technique;
• Liquorosorption method;
• The technique of washing the cerebral chambers of the ventricles with an artificial fluid, which is identical in its properties to the cerebrospinal one;
• Shunting of the ventriculoperitoneal type. This technique is carried out with blockade of the liquor bed, or with a hydrocephalic type syndrome. The method of treatment consists in inserting a drainage tube into the ventricles. This tube extends from the brain under the skin into the abdominal cavity, where cerebrospinal fluid (CSF) is absorbed. The drainage system must be operated continuously and the drainage hose must be replaced as necessary.

Is there a cure for hydrocephalus?

If the hydrocephalus pathology has produced irreversible effects in the organ, and there is no positive result from drug therapy with fibrinolytics, then the only correct way to save a life is This is a surgical intervention in the body to establish a permanent drainage of cerebrospinal fluid:

• Installation of permanent drainage with silicone tube. The tube is removed after the normalization of the child's condition and only after the hydrocephalus has ceased to progress;
• The imposition of anastomoses by endoscopic technique between the ventricles of the brain organ and the basal basin.

Preventive measures of pathology inside the ventricular outpouring of blood

There are no techniques that can 100.0% avoid hemorrhage in the IVH brain, but, To reduce the number of risk factors, you can take some precautions:

• The first event is the definition of the tactics of the generic process;
• With a narrow pelvis of a woman in labor and with a large diameter of the baby's head, the birth process should be a caesarean section;
• With poor blood coagulation in the fetus (genetic intrauterine pathologies), or in a woman in labor, a caesarean section is used.

Immediately after the birth of a child, drug therapy is prescribed to correct the coagulation of blood plasma:

• Preparations of the group of corticosteroids;
• Medicines of the immunoglobulin group;
• A platelet mass solution is administered by intra-arterial injection.

Drug therapy to correct plasma coagulation

Preventive measures (VZHK) for a future woman in labor

Since this disease cannot be prevented, Then, to facilitate the birth process, you can take some preventive measures:

• During the period of intrauterine formation of a baby, a pregnant woman should visit the attending doctor systematically;
• Systematically undergo clinical laboratory studies in order to determine deviations in the formation of the fetus and the development of intrauterine pathologies;
• Timely treat diseases of an infectious type in a pregnant woman, as well as treat pathologies in a baby in utero;
• Pass instrumental research;
• Talk to your doctor about the risk of having a baby prematurely. If there is a factor provocateur of preterm labor, then the doctor will prescribe a medication course with drugs to strengthen the cerebral arteries of the fetus, which will reduce the risk of generic IVH;
• A pregnant woman must observe a healthy lifestyle: no nervous stress, give up nicotine addiction, do not drink alcoholic beverages;
• Constantly adjust the blood pressure index;
• Avoid sudden changes in temperature;
• Don't be in the heat.

Prognosis for life with IVH

The prognosis for life with IVH directly depends on the degree of cerebral hemorrhage.

• 1 degree (mild) in which important centers of the brain are not affected, the prognosis is favorable.
• 2 degree ( medium severity) , in which the ventricles are half filled, but do not have stretched membranes - the prognosis is favorable with the qualified help of the attending doctors.
• 3 degree (severe) hemorrhage is aggravated by hydrocephalus of the brain.

Hydrocephalus occurs in 55.0% of newborns with hemorrhage.

35.0% get significant deviations in the functioning of the brain of a neurological nature.

20.0% of cases of IVH are fatal in infants.

With timely surgery to drain the cerebrospinal fluid, the chances of life increase slightly and the prognosis is slightly favorable.

IVH degree 4 is the most difficult degree in treatment. Applies only surgical technique, but even with timely therapy, 50.0% of babies die on the first day after the birth process.

80.0% of babies suffer from the pathology of hydrocephalus, which also often leads to death - the prognosis is unfavorable.

90.0% of infants have neurological disorders that lead to a shortened life span.

Grade 3 and 4 IVH - the prognosis is unfavorable.

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

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

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

Who is at risk?

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

Prerequisites for VZhK:

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

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

The risk of cerebral hemorrhage in a child increases with:

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

Characteristic symptoms

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

The most common symptoms of intraventricular hemorrhage in infants are:

• decrease or disappearance of the Moro reflex (to external stimuli);
• decreased muscle tone;
• sleepy state;
• episodes of apnea (stopping breathing);
• skin pallor, cyanosis;
• refusal of food, weakness of sucking reflexes;
• oculomotor disorders;
• weak and piercing cry;
• muscle twitching, convulsions;
• paresis;
• metabolic acidosis (acid-base balance is disturbed);
• decrease in hematocrit or lack of its increase against the background of blood transfusion;
• a large fontanel is tense and bulges;
• coma (with severe hemorrhages, as well as concomitant hemorrhages in the cerebral cortex, significant stretching of the ventricles).

Severity

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

1. IVH 1 and 2 degrees. Hemorrhage is observed in the projection of the germinal matrix and does not extend into the lumen of the lateral ventricles. In the second stage, the hemorrhage is slightly larger (>1 cm) than in the first.
2. At grade 3, hemorrhage from the germinal matrix enters the lumen of the lateral ventricles. As a result, posthemorrhagic ventriculomegaly or hydrocephalus develops. On the tomogram and section, there is an expansion of the ventricles, in which blood elements are clearly visible.
3. Grade 4 is the most severe, there is a breakthrough of IVH into the periventricular parenchyma. Hemorrhage is observed not only in the lateral ventricles, but also in the substance of the brain.

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

Diagnostic methods and criteria

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

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

Possibilities of modern medicine

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

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

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

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

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

Prognosis depending on the degree of hemorrhage

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

1. Grade 1 and 2 hemorrhages often do not require any treatment. These infants need to be monitored and there is little chance that any neurological abnormalities will develop. Cases of development of hydrocephalus and death at 1 and even 2 degrees of violation are extremely rare.
2. 3 degree. With a breakthrough hemorrhage in the ventricles, the likelihood of developing hydrocephalus increases, it can occur in about 55 percent of cases. Neurological abnormalities are observed in 35%. A lethal outcome occurs on average in every fifth child. Surgery is indicated for patients, and the outcome depends on the extent of brain damage, on the location (the prognosis is more favorable if IVH is present within only one lobe, especially only in the frontal lobe).
3. 4 degree. Unfortunately, the prognosis for such a severe pathology is disappointing. Surgical intervention in this case is inevitable, while the risks of death remain high - about half of infants with IVH of the 4th degree die. In 80% of cases, hydrocephalus develops, in 90% - neurological abnormalities.

Preventive measures

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

Correct definition of tactics of delivery

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

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

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

Prenatal screening

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

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

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

I. Definition. Intraventricular hemorrhage (IVH) is a disease that occurs mainly in premature babies. IVH is diagnosed in 45% of newborns with birth weight less than 1500 g and in 80% of newborns with birth weight less than 1000 g. Although there are reports of prenatal IVH, cerebral ventricular hemorrhage usually occurs soon after birth: 60% in the first 24 hours, 85% in the first 72 hours and 95% in the first week of life.

A. Subependymal germinal matrix. The germinal matrix is ​​present in premature newborns, but it disappears by 40 weeks of gestation. This is an area rich in thin-walled vessels that is the site of production of neurons and glial cells in the cortex and basal ganglia.

B. Changes in blood pressure. A sudden increase in arterial or venous pressure leads to hemorrhage into the germinal matrix.

B. Breakthrough hemorrhage into the germinal matrix through the ependyma leads to IVH in 80% of newborns.

G. Hydrocephalus. Acute development of hydrocephalus may result from obstruction of the cerebral aqueduct or, more rarely, from the foramina of Monroe. Slowly progressive hydrocephalus sometimes develops as a result of obliterating arachnoiditis in the posterior cranial fossa.

D. Parenchymal hemorrhage. In 20% of newborns with IVH, concomitant parenchymal hemorrhage occurs in the area of ​​ischemia or cerebral infarction.

A. High risk factors

1. Deep prematurity.

2. Asphyxia in childbirth.

6. Respiratory distress syndrome.

8. Sudden increase in blood pressure.

B. Other risk factors include administration of sodium bicarbonate, rapid volume replacement, functioning ductus arteriosus, increased central venous pressure and impaired hemostasis.

IV. Classification. Any classification of IVH must take into account the location of the hemorrhage and the size of the ventricles. Many classifications have been proposed, but the classification developed by Papile is currently the most widely used. Although it was based on computed tomography data, it is used to interpret ultrasound results.

A. Grade I. Subependymal hemorrhage into the germinal matrix.

B. Grade II. Breakthrough hemorrhage in the ventricles of the brain without their dilatation.

B. Grade III. Intraventricular hemorrhage with ventricular dilatation.

D. Grade IV. Intraventricular and parenchymal hemorrhage.

V. Clinical manifestations. Clinical manifestations of IVH are extremely diverse. Symptoms may be completely absent or expressed in tension of the fontanel, a sudden decrease in hematocrit, apnea, bradycardia, acidosis, convulsions, changes in muscle tone and consciousness. The catastrophic course of the disease is characterized by rapid development stupor or coma, respiratory failure, tonic convulsions, "decerebrate" posture, lack of pupillary response to light, lack of movement eyeballs in response to vestibular stimuli and quadriparesis.

A. Symptoms and signs of IVH may be similar to those of other common neonatal conditions such as metabolic disorders, asphyxia, sepsis, and meningitis.

B. Diagnosis based on clinical symptoms, may be wrong.

1. Among newborns with IVH confirmed by computed tomography, only 60% of the diagnosis was assumed on the basis of clinical data.

2. Among neonates with IVH documented by computed tomography, only 25% were diagnosed with hemorrhage based on clinical criteria.

A. Laboratory research

1. The results of the study of cerebrospinal fluid correspond normal indicators in about 20% of newborns with IVH.

2. When examining cerebrospinal fluid, an increased number of erythrocytes and leukocytes is usually detected in combination with an increase in protein concentration.

3. It is often difficult to differentiate IVH from "traumatic puncture".

4. A few days after the hemorrhage, the cerebrospinal fluid becomes xanthochromic, the sugar concentration decreases.

5. It is often difficult to make a correct diagnosis based on the results of CSF examination, so the use of echoencephalography or computed tomography is required to confirm IVH.

B. Radiological studies. Ultrasound and computed tomography are of great diagnostic value.

1. Prevention of preterm birth and perinatal asphyxia can prevent many cases of IVH.

2. Must follow general principles care of premature babies in order to maintain a stable acid-base balance and avoid fluctuations in arterial and venous pressure.

3. Pharmacological prevention. The efficacy and safety of none of the drugs listed below has been proven.

(1) Mother. Administer a slow dose of 500 mg intravenously followed by 100 mg by mouth every 24 hours until labor occurs or ends.

(2) Newborn. Administer 2 doses of 10 mg/kg IV each 12 hours apart, followed by 2.5 mg/kg every 12 hours IV, IM, or by mouth for 6 days.

b. Pancuronium; Give 0.1 mg/kg intravenously as many times as necessary to ensure muscle relaxation in the first 72 hours of life.

v. Indomethacin. The course consists of 5 doses of 0.1 mg/kg intravenously every 12 hours.

d. Ethamsylate (125 mg/ml). Give 0.1 ml/kg IV for the first 2 hours of life, then every 6 hours for 4 days. (Currently not applicable in the US.)

e. Vitamin E. Administer 20 mg/kg intramuscularly once a day for 3 days.

B. Screening ultrasound or computed tomography

1. All newborns weighing less than 1500 g should be examined.

2. Newborns with greater body weight should be examined for risk factors for IVH or signs of increased intracranial pressure and hydrocephalus.

3. The optimal age for the diagnosis of IVH is 4-7 days of age, a re-examination should be performed on the 14th day.

4. The optimal age for the diagnosis of hydrocephalus is 14 days of age, a control study is indicated at the age of 3 months.

5. The advantages of echoencephalography are satisfactory resolution, equipment portability and no radiation exposure. On computed tomography, IVH may not be identified within 7-14 days after the hemorrhage.

B. Acute hemorrhage

1. Stabilization and general support measures

a. Maintain perfusion pressure in the brain by maintaining adequate blood pressure.

b. Maintain adequate circulating blood volume and acid-base balance.

2. Conduct dynamic studies (ultrasound or computed tomography) in order to exclude the progression of hydrocephalus.

3. Randomized controlled trials of the effectiveness of serial lumbar punctures to prevent the development of posthemorrhagic hydrocephalus did not reveal a significant difference between the main group of newborns who received lumbar punctures along with maintenance therapy, and the control group, which received only maintenance therapy.

With a mild form of hydrocephalus, the size of the ventricles ceases to increase without additional treatment.

VIII. Forecast. The prognosis depends on the severity of the hemorrhage.

A. Grade I and II. There is no difference in morbidity and mortality among neonates with grade I and II IVH and children without IVH up to 2 years of age.

B. Grade III. Up to 80% of children have severe neurological disorders.

B. Grade IV. Almost all children (90%) die or have severe complications.

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Intraventricular hemorrhage in newborns

The cause of intraventricular hemorrhage in newborns is usually hypoxia or trauma. They are rarely associated with primary coagulopathy or congenital vascular anomalies.

Traumatic genesis of epidural, subdural or subarachnoid hemorrhage is especially likely when the size of the head does not match the size of the mother's pelvis, a long period of exile, rapid delivery, breech presentation, obstetric operations. Massive subdural hemorrhages accompanying rupture of the cerebellum or falx are rare. They are more common in full-term newborns than in preterm ones. Rarely, primary coagulopathy and vascular malformations are also encountered, which are the causes of subarachnoid and parenchymal hemorrhages. Intracranial hemorrhages are also observed in disseminated intravascular coagulation, isoimmune thrombocytopenia and vitamin K deficiency (in particular, in children whose mothers received phenobarbital or phenytoin). In preterm infants, intracranial (predominantly intraventricular) hemorrhages occur in the absence of overt trauma.

Pathogenesis

Premature infants are especially susceptible to brain damage. Most of these lesions are intraventricular hemorrhages and periventricular leukomalacia. Intraventricular hemorrhages in preterm infants originate from the gelatinous germinal matrix. It contains embryonic neurons and glial cells, migrating from here to the cerebral cortex. Predisposing to hemorrhage is the presence of immature vessels in this richly vascularized area in preterm infants that do not have sufficient support in the tissues. In full-term babies, the vessels of the germinal matrix mature and acquire a stronger support in the tissues. Among the factors predisposing to intraventricular hemorrhages in newborns are prematurity, hyaline membrane disease, cerebral hypoxia and ischemia, arterial hypotension, restoration of blood flow in ischemic areas of the brain, fluctuations in cerebral blood flow, violation of the integrity of the vascular wall, increased venous pressure, pneumothorax, hypovolemia , arterial hypertension. These disorders lead to rupture of the vessels of the germinal matrix. The same damaging effects (hypoxia, ischemia, arterial hypotension), obstruction of the veins due to intraventricular hemorrhage in newborns, and some other, unidentified disorders cause periventricular hemorrhages and necrosis (look like echo-rich areas).

Clinical manifestations

The frequency of intraventricular hemorrhages in newborns is inversely proportional to birth weight and gestational age: with masseg - 60-70%, g - 10-20%. At birth, intraventricular hemorrhages are rare. 80-90% of them occur in the first 3 days of life, 50% - in the 1st day. In 12-40% of cases, hemorrhage increases in the first week. 10-15% of hemorrhages occur after the first week of life. After the first month of life, regardless of birth weight, hemorrhages are rare. The most common symptoms of intraventricular hemorrhage in newborns are a decrease or disappearance of the Moro reflex, muscle hypotension, drowsiness, and apnea episodes. In preterm infants, intraventricular hemorrhages are manifested by a rapid deterioration in the condition on the 2nd-3rd day of life: episodes of apnea, pallor, cyanosis, refusal to eat, oculomotor disorders, a weak piercing cry, muscle twitches and convulsions, muscle hypotension or paresis, metabolic acidosis, shock, drop in hematocrit or the absence of its increase after hemotransfusion due to its fall. The large fontanel is often tense and bulges. With severe intraventricular hemorrhages, concomitant hemorrhages in the cerebral cortex, stretching of the ventricles, CNS depression deepens up to coma.

Periventricular leukomalacia in newborns is usually asymptomatic and manifests itself closer to the age of 1 year with spastic paresis and delayed motor development.

Diagnostics

Diagnosis of intraventricular hemorrhage is based on history, clinical presentation, transfontanular ultrasound or CT data, and assessment of risk factors associated with birth weight. Subdural hemorrhages in large full-term newborns, whose head size does not correspond to the size of the mother's pelvis, are often diagnosed late, at the age of about 1 month, when the gradual accumulation of subdural exudate leads to an increase in head circumference, an overhang of the forehead, bulging of the large fontanelle, convulsive seizures and anemia. A belated manifestation sometimes suggests child abuse. Subarachnoid hemorrhages can cause short-term convulsions in a relatively mild condition.

Although in preterm infants massive intraventricular hemorrhages quickly give bright clinical manifestations - shock, marble-cyanotic skin coloration, anemia, coma, bulging of a large fontanelle, many symptoms are absent or non-specific. All premature babies to detect intraventricular hemorrhage recommended ultrasound of the brain through a large fontanel. Newborns with birth weight less than 1500 g, gestation less than 30 weeks, i.e., belonging to the risk group for intraventricular hemorrhage, should have an ultrasound scan at 7-14 days of life and repeat it every week. post-conception age. If the first ultrasound revealed pathological changes, it is necessary to repeat it earlier so as not to miss posthemorrhagic hydrocephalus. Multiple ultrasounds make it possible to diagnose later developing atrophy of the cerebral cortex, porencephaly, to judge the severity, increase or decrease in posthemorrhagic hydrocephalus. Diffusion-weighted MRI facilitated early diagnosis Widespread periventricular leukomalacia, white matter damage and isolated cerebral infarction and parenchymal hemorrhages.

According to ultrasound data, three degrees of severity of intraventricular hemorrhages in preterm infants are distinguished: I - subependymal hemorrhage within the germinal matrix or occupying less than 10% of the volume of the ventricle (35% of cases), II - hemorrhage into the ventricle, occupying 10-50% of its volume (40% of cases ) and III - hemorrhage into the ventricle, occupying more than 50% of its volume. Another classification includes another IV degree, which corresponds to III + parenchymal hemorrhage. Ventriculomegaly is classified as mild (0.5-1.0 cm), moderate (1.0-1.5 cm), and severe (> 1.5 cm).

To term infants with clinical picture brain lesions, CT or MRI is indicated, since ultrasound does not always detect parenchymal hemorrhages and heart attacks. With symptoms of intracranial hypertension against the background of a deterioration in the condition, a lumbar puncture is necessary to exclude bacterial meningitis and confirmation of the diagnosis of massive subarachnoid hemorrhage. With the latter, the content of protein and erythrocytes in the CSF is increased, leukocytosis and some decrease in glucose levels are not uncommon. A slight increase in the number of red blood cells and mild xanthochromia have no diagnostic value, since small subarachnoid hemorrhages occur during normal childbirth and even caesarean section. Conversely, CSF may be completely normal with massive subdural or parenchymal hemorrhage not communicating with the subarachnoid space.

Forecast

Massive hemorrhages with rupture of the cerebellum or falx of the brain cause lightning deterioration and death shortly after birth. Massive intrauterine hemorrhages in the brain, in particular in its cortex, occur with isoimmune thrombocytopenic purpura in the mother or, more often, with isoimmune thrombocytopenia. After their resorption, porencephalic cysts remain.

Intraventricular hemorrhages and acute ventricular dilatation do not cause posthemorrhagic hydrocephalus in most cases. The latter develops in 10-15% of preterm infants who have had intraventricular hemorrhages. At first, it may not be accompanied by characteristic symptoms ( fast growth head circumference, episodes of apnea and bradycardia, CNS depression, bulging of the large fontanelle, divergence of the sutures of the skull). They, despite the steady expansion of the ventricles, compression and atrophy of the cerebral cortex, appear only after 2-4 weeks. In 65% of cases, posthemorrhagic hydrocephalus ceases to grow or undergoes a reverse development.

With progressive hydrocephalus, ventriculoperitoneal shunting is indicated. Parenchymal hemorrhages and extensive periventricular leukomalacia aggravate the prognosis. Intraventricular hemorrhages in newborns, in which the size of the echo dense area in the parenchyma exceeds 1 cm, are accompanied by high mortality and frequent motor and cognitive disorders. Intraventricular hemorrhages of grades I-II are not associated with severe hypoxia and ischemia and, in the absence of concomitant parenchymal hemorrhages and periventricular leukomalacia, rarely cause severe residual neurological disorders.

Prevention

A careful assessment of the ratio of the size of the fetal head and the mother's pelvis in determining the tactics of delivery significantly reduces the incidence of traumatic intracranial hemorrhages. The incidence of perinatal intracranial hemorrhage associated with maternal idiopathic thrombocytopenic purpura or fetal isoimmune thrombocytopenia is reduced by maternal corticosteroid therapy and intravenous administration her immunoglobulin, platelet transfusion to the fetus and delivery by caesarean section. All women who received phenobarbital and phenytoin during pregnancy should be given vitamin K before delivery. Fluctuations in blood pressure should be avoided in newborns.

A single administration of corticosteroids to a preterm woman reduces the incidence of intraventricular hemorrhage in newborns (betamethasone and dexamethasone) and periventricular leukomalacia (betamethasone alone). How effective their repeated administration is and whether it will affect brain growth and psychomotor development is unknown. Preventive use small doses of indomethacin reduces the frequency of intraventricular hemorrhages, but in general does not affect the prognosis.

Treatment of intraventricular hemorrhages in newborns

There are no treatments. Therapy is directed at their complications. Convulsions require active anticonvulsant therapy, massive blood loss and shock require transfusions of red blood cells and fresh frozen plasma. Correction of acidosis is necessary, including sodium bicarbonate, provided that it is slowly administered. External CSF drainage by insertion of an indwelling catheter into the lateral ventricle is used in the early period of rapidly and steadily progressive hydrocephalus as a temporary measure until general state a very low birth weight infant would allow ventriculoperitoneal shunting. Serial lumbar punctures, diuretics and acetazolamide (diacarb) do not play a real role in the treatment of posthemorrhagic hydrocephalus.

Clinically significant subdural hematomas are aspirated by inserting a lumbar puncture needle through the large fontanel at its lateral edge. It should be remembered that the cause of subdural hemorrhage can be not only birth injury, but also cruel treatment with child.

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IVH of the newborn

Intraventricular hemorrhage (IVH) is one of the most common ailments that occur at birth in premature babies. Babies born prematurely have incompletely formed blood vessels in the brain. Due to their vulnerability, the thinnest walls of blood vessels are subject to the slightest pressure fluctuations. Due to hypoxia and birth trauma, immature vessels rupture, blood flows into various parts of the ventricles in the brain, forming IVH.

Despite the rather frequent occurrence of this problem in premature babies, IVH can also develop in newborns with normal weight. A change in pressure in the brain can develop due to hypoxia during childbirth, the presence of infections in the mother, mechanical injuries. All these factors may well provoke the development of IVH in term infants. razvitierebenca.ru

We highlight the main factors that increase the risk of developing IVH:

• infectious diseases in the mother, leading to impaired blood clotting;
• respiratory failure during childbirth;
• prolonged or rapid childbirth;
• lack of vitamin K, causing a violation of blood clotting;
• mechanical impact on the fetus (when applying forceps or applying a vacuum).

IVH severity

Depending on the localization of the spread of hemorrhage, IVH is divided into 4 degrees of severity.

At the I degree, the blood affects only the walls of the ventricles;

At II degree, blood penetrates into the cavity;

At the III degree there is an extensive hemorrhage, leading to the expansion of the lateral ventricles. This process can lead to hydrocephalus.

In the IV degree, blood enters the brain tissue, affecting it.

IVH symptoms in newborns

IVH I and II degree may be asymptomatic. Much more dangerous is the development of IVH of III and IV degrees. In such cases, fluid can accumulate in the ventricles of the brain, which can cause the development of dropsy, hydrocephalus, and brain atrophy.

The main signs indicating the possible presence of IVH:

• swelling of the fontanelles in the upper part of the head;
• weak sucking reflex;
• respiratory failure;
• lethargy, apathy;
• increased muscle tone;
• muscle spasms.

It is impossible to make this diagnosis on your own. There are many diseases that have similar symptoms with IVH, so it is better to leave the diagnosis to a specialist. Even in the hospital, the baby will be examined by a neonatologist. In the absence of visible signs, the child will still remain under observation for several days.

In many maternity hospitals, ultrasound of all newborns is practiced today. Do not refuse this procedure, even if you were not directed to it. With the help of ultrasound, the doctor will check the abdominal organs and the head of the baby. The slightest deviations from the norm will help buy time, and not start the treatment of those diseases that are not visible visually.

If the doctor sent the child for an ultrasound, there is a risk of rupture of blood vessels. In this case, the diagnosis should be immediate.

In parallel, tests may be prescribed to detect anemia and infections. Child development.ru

IVH treatment

As such, IVH is not treated, because it is not a disease, but a process that provokes the development of complications in the activity of the brain.

When IVH is detected, its degree is first assessed. In the presence of І and ІІ degrees, the child's condition is monitored. If it remains stable, drugs are prescribed to eliminate the effects of hemorrhage. For example, anticonvulsant therapy, correction of anemia.

In grades III and IV, a neurosurgical operation may be required. For example, with hydrocephalus, shunting of the ventricles of the brain is prescribed.

Premature babies need to be provided with a strict protected regime, similar to intrauterine conditions. For this, the child is placed in a special incubator until the condition stabilizes.

The development of complications directly depends on the degree of damage to the ventricles. Hemorrhages of I and II degrees may not cause neurological pathology at all, while extensive hemorrhages of III and IV degrees can lead to disability and even death.

When the ventricular cavity expands, urgent bypass surgery may be required. Untimely detection and operation in case of extensive hemorrhage can lead to a violation of the development of motor functions, the development of cerebral palsy, and a general developmental delay. Often IVH is the cause of future neuropsychological problems. In rare cases, there are problems with hearing and vision, up to blindness and deafness.

Prevention of IVH

It is rather difficult to prevent the development of IVH, since this process occurs spontaneously and is not subject to control. However, there are some steps you can take to reduce your risk of developing IVH.

1. During pregnancy, you must regularly visit a doctor, take all the prescribed tests. Even the simplest clinical blood test will help to identify the slightest deviations in the early stages, and prevent their further development in time.
2. Consult your doctor. If there is a risk of having a baby prematurely, the doctor will select drugs that reduce the risk of hemorrhage.
3. In the third trimester of pregnancy, undergo a preventive examination, at which the doctor will assess the ratio of the size of the fetus's head to the mother's pelvis. This will help determine the tactics of delivery, significantly reducing the likelihood of developing IVH.
4. During pregnancy, follow the regimen, lead a healthy lifestyle, do not abuse fluids, especially in the third trimester. Any fluctuations in blood pressure are a reason to consult a doctor.
5. If you're not intolerant of heat, try to minimize prolonged sun exposure. Temperature fluctuations negatively affect the vessels, and are by no means useful to the unborn child.

Remember that the successful outcome of childbirth is planning pregnancy in advance.

The cause of intraventricular hemorrhage in newborns is usually hypoxia or trauma. They are rarely associated with primary coagulopathy or congenital vascular anomalies.

Traumatic genesis of epidural, subdural or subarachnoid hemorrhage is especially likely when the size of the head does not match the size of the mother's pelvis, a long period of exile, rapid delivery, breech presentation, obstetric. Massive subdural hemorrhages accompanying rupture of the cerebellum or falx are rare. They are more common in full-term newborns than in preterm ones. Rarely, primary coagulopathy and vascular malformations are also encountered, which are the causes of subarachnoid and parenchymal hemorrhages. Intracranial hemorrhages are also observed in disseminated intravascular coagulation, isoimmune thrombocytopenia and vitamin K deficiency (in particular, in children whose mothers received phenobarbital or phenytoin). In preterm infants, intracranial (predominantly intraventricular) hemorrhages occur in the absence of overt trauma.

Pathogenesis

Premature infants are especially susceptible to brain damage. Most of these lesions are intraventricular hemorrhages and periventricular leukomalacia. Intraventricular hemorrhages in preterm infants originate from the gelatinous germinal matrix. It contains embryonic neurons and glial cells, migrating from here to the cerebral cortex. Predisposing to hemorrhage is the presence of immature vessels in this richly vascularized area in preterm infants that do not have sufficient support in the tissues. In full-term babies, the vessels of the germinal matrix mature and acquire a stronger support in the tissues. Among the factors predisposing to intraventricular hemorrhages in newborns are prematurity, hyaline membrane disease, hypoxia and ischemia of the brain, arterial hypotension, restoration of blood flow in ischemic areas of the brain, fluctuations in cerebral blood flow, violation of the integrity of the vascular wall, increased venous pressure, hypovolemia, arterial hypertension. These disorders lead to rupture of the vessels of the germinal matrix. The same damaging effects (hypoxia, ischemia, arterial hypotension), obstruction of the veins due to intraventricular hemorrhage in newborns, and some other, unidentified disorders cause periventricular hemorrhages and necrosis (look like echo-rich areas).

Clinical manifestations

The frequency of intraventricular hemorrhages in newborns is inversely proportional to birth weight and gestational age: with a weight of 500-750 g - 60-70%, 1000-1500 g - 10-20%. At birth, intraventricular hemorrhages are rare. 80-90% of them occur in the first 3 days of life, 50% - in the 1st day. In 12-40% of cases, hemorrhage increases in the first week. 10-15% of hemorrhages occur after the first week of life. After the first month of life, regardless of birth weight, hemorrhages are rare. The most common symptoms of intraventricular hemorrhage in newborns are a decrease or disappearance of the Moro reflex, muscle hypotension, drowsiness, and apnea episodes. In preterm infants, intraventricular hemorrhages are manifested by a rapid deterioration in the condition on the 2nd-3rd day of life: episodes of apnea, pallor, cyanosis, refusal to eat, oculomotor disorders, a weak piercing cry, muscle twitches and convulsions, muscle hypotension or paresis, metabolic acidosis, shock, drop in hematocrit or the absence of its increase after hemotransfusion due to its fall. The large fontanel is often tense and bulges. With severe intraventricular hemorrhages, concomitant hemorrhages in the cerebral cortex, stretching of the ventricles, CNS depression deepens up to coma.

Periventricular leukomalacia in newborns is usually asymptomatic and manifests itself closer to the age of 1 year with spastic paresis and delayed motor development.

Diagnostics

Diagnosis of intraventricular hemorrhage is based on history, clinical presentation, transfontanular or CT findings, and assessment of risk factors associated with birth weight. Subdural hemorrhages in large full-term newborns, whose head size does not correspond to the size of the mother's pelvis, are often diagnosed late, at the age of about 1 month, when the gradual accumulation of subdural exudate leads to an increase in head circumference, an overhang of the forehead, bulging of the large fontanelle, convulsive seizures and . A belated manifestation sometimes suggests child abuse. Subarachnoid hemorrhages can cause short-term convulsions in a relatively mild condition.

Although in preterm infants massive intraventricular hemorrhages quickly give bright clinical manifestations - shock, marble-cyanotic skin coloration, anemia, coma, bulging of a large fontanelle, many symptoms are absent or non-specific. All premature babies to detect intraventricular hemorrhage recommended ultrasound of the brain through a large fontanel. Newborns with a birth weight of less than 1500 g, a gestation of less than 30 weeks, i.e., belonging to the risk group for intraventricular hemorrhage, should undergo ultrasound at 7-14 days of life and repeat it at 36-40 weeks. post-conception age. If the first ultrasound revealed pathological changes, it is necessary to repeat it earlier so as not to miss posthemorrhagic hydrocephalus. Multiple ultrasounds make it possible to diagnose later developing atrophy of the cerebral cortex, porencephaly, to judge the severity, increase or decrease in posthemorrhagic hydrocephalus. Diffusion-weighted MRI has facilitated the early diagnosis of advanced periventricular leukomalacia, white matter injury and isolated cerebral infarction, and parenchymal hemorrhage.

According to ultrasound data, three degrees of severity of intraventricular hemorrhages in preterm infants are distinguished: I - subependymal hemorrhage within the germinal matrix or occupying less than 10% of the volume of the ventricle (35% of cases), II - hemorrhage into the ventricle, occupying 10-50% of its volume (40% of cases ) and III - hemorrhage into the ventricle, occupying more than 50% of its volume. Another classification includes another IV degree, which corresponds to III + parenchymal hemorrhage. Ventriculomegaly is classified as mild (0.5-1.0 cm), moderate (1.0-1.5 cm), and severe (> 1.5 cm).

CT or MRI is indicated for full-term babies with a clinical picture of brain damage, since ultrasound does not always detect parenchymal hemorrhages and heart attacks. With symptoms of intracranial hypertension against the background of deterioration, a lumbar puncture is necessary to exclude bacterial meningitis and confirm the diagnosis of massive subarachnoid hemorrhage. With the latter, the content of protein and erythrocytes in the CSF is increased, leukocytosis and some decrease in glucose levels are not uncommon. A slight increase in the number of red blood cells and mild xanthochromia have no diagnostic value, since small subarachnoid hemorrhages occur during normal childbirth and even caesarean section. Conversely, CSF may be completely normal with massive subdural or parenchymal hemorrhage not communicating with the subarachnoid space.

Forecast

Massive hemorrhages with rupture of the cerebellum or falx of the brain cause lightning deterioration and death shortly after birth. Massive intrauterine hemorrhages in the brain, in particular in its cortex, occur with isoimmune thrombocytopenic purpura in the mother or, more often, with isoimmune thrombocytopenia. After their resorption, porencephalic cysts remain.

Intraventricular hemorrhages and acute ventricular dilatation do not cause posthemorrhagic hydrocephalus in most cases. The latter develops in 10-15% of preterm infants who have had intraventricular hemorrhages. At first, it may not be accompanied by characteristic symptoms (rapid increase in head circumference, episodes of apnea and bradycardia, CNS depression, bulging of the large fontanel, divergence of the sutures of the skull). They, despite the steady expansion of the ventricles, compression and atrophy of the cerebral cortex, appear only after 2-4 weeks. In 65% of cases, posthemorrhagic hydrocephalus ceases to grow or undergoes a reverse development.

With progressive hydrocephalus, ventriculoperitoneal shunting is indicated. Parenchymal hemorrhages and extensive periventricular leukomalacia aggravate the prognosis. Intraventricular hemorrhages in newborns, in which the size of the echo dense area in the parenchyma exceeds 1 cm, are accompanied by high mortality and frequent motor and cognitive disorders. Intraventricular hemorrhages of grades I-II are not associated with severe hypoxia and ischemia and, in the absence of concomitant parenchymal hemorrhages and periventricular leukomalacia, rarely cause severe residual neurological disorders.

Prevention

A careful assessment of the ratio of the size of the fetal head and the mother's pelvis in determining the tactics of delivery significantly reduces the incidence of traumatic intracranial hemorrhages. The frequency of perinatal intracranial hemorrhages associated with idiopathic thrombocytopenic purpura in the mother or isoimmune thrombocytopenia in the fetus is reduced when the mother is given corticosteroid therapy and intravenous immunoglobulin, platelet transfusion to the fetus and delivery by caesarean section. All women who received phenobarbital and phenytoin during pregnancy should be given vitamin K before delivery. Fluctuations in blood pressure should be avoided in newborns.

A single administration of corticosteroids to a preterm woman reduces the incidence of intraventricular hemorrhage in newborns (betamethasone and dexamethasone) and periventricular leukomalacia (betamethasone alone). How effective their repeated administration is and whether it will affect brain growth and psychomotor development is unknown. Prophylactic use of low doses of indomethacin reduces the frequency of intraventricular hemorrhage, but in general does not affect the prognosis.

Treatment of intraventricular hemorrhages in newborns

There are no treatments. Therapy is directed at their complications. Convulsions require active anticonvulsant therapy, massive and shock - transfusion of red blood cells and fresh frozen plasma. Correction of acidosis is necessary, including sodium bicarbonate, provided that it is slowly administered. External CSF by placement of an indwelling catheter into the lateral ventricle is used in the early stages of rapidly and steadily progressive hydrocephalus as a temporary measure until the general condition of the very low birth weight infant allows ventriculoperitoneal shunting. Serial lumbar punctures, diuretics and acetazolamide (diacarb) do not play a real role in the treatment of posthemorrhagic hydrocephalus.

Clinically significant subdural hematomas are aspirated by inserting a lumbar puncture needle through the large fontanel at its lateral edge. It should be remembered that the cause of subdural hemorrhage can be not only birth trauma, but also child abuse.

The article was prepared and edited by: surgeon