Hemorrhage into the cerebellum in newborns. Intracranial hemorrhage in newborns: causes, treatment

Ischemia-hypoxia, changes in blood pressure and pressure. The presence of germinal matrix makes bleeding more likely. The risk also increases with hematologic diseases (eg, vitamin K deficiency, hemophilia, disseminated intravascular coagulation).

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

Subdural hemorrhage, now less common due to improved obstetric techniques, results from bleeding into the falciform space, tentorium, or commissuruven. Such bleeding typically occurs in newborns of first-time mothers, large newborns, or after a complicated birth—conditions that can produce unusual pressure on intracranial vessels. Symptoms may include seizures; rapid head enlargement or abnormal neurological examination results.

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

Risk: Premature newborns are at risk intracerebral hemorrhage and its severity is directly proportional to the degree of immaturity:

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

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

Sources of bleeding:

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

As the newborn matures, the importance of the germinal matrix as a source of intracerebral hemorrhage decreases, and the importance of the choroid plexus increases.

Classification of intracerebral hemorrhage in newborns

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

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

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

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

• Hemorrhage of the 1st degree: subependymal.
• Grade II hemorrhage: intraventricular with filling< 50 % просвета.
• Hemorrhage grade 111: intraventricular with filling > 50% of the lumen.
• Parenchymal hemorrhages ( big brain, cerebellum, basal ganglia, brain stem) are described separately (localization and size).

Diagnosis of intracerebral hemorrhage in newborns

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

In addition, blood tests, CBC and metabolic studies should be performed.

Ultrasonography

Premature infants should undergo cranial ultrasound on the first, third and seventh days of life. It also makes sense to perform an ultrasound after the child’s admission to the department (in case of forensic investigations to clarify the time of the first manifestation of the lesion).

If a lesion is detected, a thorough examination of the midbrain and infratentorial structures is necessary through additional approaches (anterior and posterior lateral fontanelles). In approximately 10% of premature infants with post-hemorrhagic dilation of the ventricles, small hemorrhages are detected in the cerebellum, which are poorly visible through the large fontanel (this clinical problem is underestimated).

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

In full-term infants, in addition to ultrasound, it is necessary to perform MRI and, if this is important for treatment, angiography.

Intraparenchymal areas of echo enhancement (the term periventricular venous perfusion or edema is often used) are the sites of infarction in most cases. Sometimes they go away without the formation of cysts, and then in retrospect we can only talk about venous stagnation. After the onset of cystic transformation (weeks), areas of echo enhancement should be called infarctions or hemorrhages (important for discussion with parents).

Differential diagnosis

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

Treatment of intracerebral hemorrhage in newborns

Treatment is primarily supportive unless hematologic abnormalities contribute to bleeding. All children should receive vitamin K if it has not been previously provided. If platelets or clotting factors are insufficient, they must be replenished. Subdural hematomas should be treated by a neurosurgeon; removal of the hemorrhage may be necessary.

Make the most of all conservative treatment options:

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

Attention: It is better to intubate electively than in an emergency situation with apnea.

For full-term infants, early consultation with a neurosurgeon.

Prognosis of intracerebral hemorrhage in newborns

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

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

In mature neonates, prognosis depends on location and cause; hemorrhages in the basal ganglia, cerebellum and brainstem have an unfavorable prognosis, but the individual course is unpredictable.

The prognosis for subarachnoid hemorrhage is usually good. For subdural, cautious, but some babies do well. Most infants with small intraventricular hemorrhages survive the episode of acute bleeding and appear well. Children with large intraventricular hemorrhage have a poor prognosis, especially if the bleeding continues into the parenchyma. Premature infants with a history of severe intraventricular hemorrhage are at risk of developing posthemorrhagic hydrocephalus and should be closely monitored with repeat cranial ultrasound and frequent repeat head circumference measurements. Infants with progressive hydrocephalus require neurosurgical intervention to place a subcutaneous ventricular reservoir (for CSF aspiration) or a ventriculoperitoneal shunt. The CSF associated with posthemorrhagic hydrocephalus has very low glucose concentrations, known as hypoglycorrachia. Because many children have persistent neurological deficits, close monitoring and referral for early intervention are important.

The brain is the most important organ of the human body. It performs the function of thinking and regulates the operation of all systems. Bleeding in the brain occurs due to injury to blood vessels. Blood enters the gray matter of the brain inside the skull.

This dangerous process causes disruptions in the functioning of the entire body. If medical assistance is not provided in time, the pathology can lead to the death of the child.

Brain hemorrhage requires mandatory medical treatment

Causes of cerebral hemorrhage in newborns

The main reasons for blood entering the brain of infants:

• infection of a child with infectious diseases during pregnancy;
• the birth of a child significantly earlier or later than the due date;
• large size of the fetal head relative to the size of the maternal birth canal;
• rapid or, conversely, prolonged labor;
• physical intervention of medical personnel in the birth process (use of forceps, vacuum extractor);
• C-section.

Hemorrhage can be detected immediately after the baby is born. Often, intracranial hematoma occurs in the first month of a baby’s life.

Types and degrees of hemorrhages

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Depending on the location, there are several types of hemorrhages:

1. epidural;
2. subarochnoid;
3. subdural;
4. intraventricular.

Epidural is the most severe type of pathology. Appears in newborns due to injury to a vessel when blood leaks into the space between the skull and the lining of the brain. Develops due to bruises and during childbirth. In this case, the child experiences:

• dilation of the pupils of the eyes;
• convulsions;
• decreased cardiac and respiratory activity;
• hypoxia.

Symptoms appear several hours after the blood vessel ruptures. It is necessary to provide immediate assistance, as the newborn may fall into a coma.

Subarochnoidal (subependymal) - hemorrhage that is localized between the lining of the brain and the gray matter (see also:). The most common type. Vessel rupture occurs during childbirth; premature babies are more susceptible to its occurrence. Characteristic symptoms:

• incessant crying, screaming as a reaction to any irritant;
• poor sleep;
• head enlargement;
• divergence and involuntary rotation of the eyeballs;
• muscle cramps.

These symptoms appear immediately and require medical procedures. If doctors act competently, the consequences for the child will be minimal.

Subdural - rupture of blood vessels between the soft tissues and the dura mater of the brain. The cause of the pathology may be rapid or prolonged labor, a large child, or the turning of the child during the birth process. Signs:

• a sharp increase in head size;
• neck muscle tension;
• convulsions.

The resulting hematoma rapidly increases. If you do not provide the necessary assistance, death will occur.

Intraventricular - blood enters the gray matter of the brain and the ventricular space. Affects children born much earlier than their due date. As a result of the pathology, the baby's sucking, swallowing and tendon reflexes may be impaired. Intraventricular hemorrhage is characterized by:

• swelling of the fontanel;
• disorders of the digestive system;
• violation of the thermoregulation process;
• anemia.

Degree of hemorrhage development:

• 1st degree. Blood does not flow into the cavity of the ventricles and brain, as it is retained by the wall of the ventricles.
• 2nd degree. Blood enters the cavity of the ventricles.
• 3rd degree. Hemorrhage is noticeable during MRI, as blood enters the lateral ventricles and the space between them.
• 4th degree. Hemorrhage into the gray matter of the brain.

Symptoms

Symptoms of a cerebral hemorrhage differ depending on the location of the ruptured vessel. General symptoms:

• loss of consciousness;
• lethargy, apathy;
• severe vomiting, frequent regurgitation;
• convulsions;
• headaches.

When blood penetrates into the deep layers of the brain, the following is observed:

• loss of consciousness;
• coma;
• lack of eye reaction to light;
• increased or slow breathing;
• decrease in temperature;
• dysfunction of the limbs.

Signs of blood entering the white or gray matter of the brain:

• convulsions;
• weakening of muscle tone;
• excitability or inhibition;
• disturbance or complete lack of sleep;
• strong, incessant crying.

When blood enters the cerebellum, the following occurs:

• profuse vomiting;
• slow coordination of movements;
• neck muscle tension;
• coma.

Consequences for children

The danger of the pathology lies in the fact that when a vessel ruptures, some areas of the brain stop receiving micronutrients and oxygen and are compressed by the accumulated fluid. The consequences depend on the speed of medical care and the degree of damage. Minor hemorrhage, if detected and treated in a timely manner, will not cause serious harm to the child. The course of treatment can range from 2 months to several years.

Consequences of a more severe form of pathology:

• coma;
• hydrocephalus (we recommend reading:);
• epilepsy;
• developmental disorder;
• cerebral edema;
• strabismus;
• speech disorders.

Treatment of pathology

Treatment methods and necessary medications are prescribed by a doctor. They depend on the location of the hemorrhage and the degree of the pathological process. Treatment is aimed at eliminating bleeding and restoring the functioning of body systems.

Therapeutic therapy includes:

• taking medications that increase the amount of urine - to reduce the risk of developing cerebral and pulmonary edema;
• puncture - puncture of the meninges to reduce intracranial pressure, as a result of which accumulated fluid is removed;
• taking hormonal drugs – in case of adrenal gland dysfunction;
• appointment of therapeutic massage and course sessions with a speech therapist.

Newborns must be cared for with care. Basic principles:

• do not allow sudden movements when changing clothes and bathing the child;
• avoid falling;
• Constantly monitor your baby's body temperature.

Some stages of hemorrhage require surgery. Surgery may be prescribed if the brain is severely damaged and the patient’s condition is serious.

Types of surgical operations:

• craniotomy;
• minimally invasive surgery;
• stereotactic removal of a blood clot.

Prevention of cerebral hemorrhages in children

Brain hemorrhage is a terrible pathology. Preventive measures should be taken to protect children from it:

• during pregnancy planning, get tested for toxoplasmosis and genitourinary infections (see also:);
• stop smoking and drinking alcoholic beverages;
• take a responsible approach to choosing a maternity hospital and a doctor who will deliver the child, take into account the reviews of your friends.

Unfortunately, no one is immune from medical errors. You need to carefully monitor the baby's condition in the first month of life.

06.09.2017

Some pathologies cause changes in the walls of the blood vessels that supply brain cells, which can cause cerebral hemorrhage in newborns. The reason lies in the mistake of doctors helping the child to be born, but there are other factors: complicated pregnancy, non-compliance by the expectant mother with the recommended regimen. For a child, such a pathology is fraught with serious complications, in particular, it can lead to cerebral palsy. There is no need to panic; you need to identify problems in time and follow medical recommendations.

Speaking about the reasons for changes in cerebral blood vessels, one cannot fail to mention oxygen deficiency due to the neglect of walks by the expectant mother. Another factor causing oxygen starvation of the fetus is disrupted metabolic processes in the body of the mother or baby.

Childbirth itself can cause hypoxia. It is important that the weight and size of the fetus are established to prevent the baby from stopping in the birth canal and associated problems.

Other causes of cerebral hemorrhage in an infant:

• childbirth after 40 weeks;
• premature and rapid labor;
• infections suffered by a pregnant woman.

Types of bleeding

To establish a prognosis, you need to determine the type of hemorrhage. Pathologies are classified based on their development and location of manifestation. Below are presented in detail the types of brain hemorrhages in infants - intracerebral and ventricular, subarachnoid, subdural.

Intracerebral hemorrhage is accompanied by blood entering the brain tissue, and intraventricular hemorrhage is characterized by blood entering the ventricles - a cavity in the brain that is filled with cerebrospinal fluid. These newborn brain hemorrhages are more common when babies are born before 32 weeks.

Minor bleeding inside the skull occurs in infants on the third day of life, but this is not dangerous for the baby. If the ventricles in the brain fill with blood, this can lead to cerebral palsy or behavioral problems in the future.

Epidural hemorrhage is a condition in which blood from damaged cerebral vessels gets between the outer shell of the brain and the skull.

Often, blood enters the brain of a newborn due to traumatic brain injuries, including skull fractures due to a fall. Symptoms will be: convulsions, suffocation, decreased blood pressure and pulse, dilated pupils on the side of the head where the bruise occurred. The clinical picture does not appear immediately, but several hours after the vessels rupture.

From this moment on, the newborn’s condition worsens; if active treatment is not started, after a few days the baby will fall into a coma from which he will not return. This is a serious type of pathology, it is better not to deal with such consequences.

Subarachnoid hemorrhages are detected more often than others. In such a situation, blood enters from the vessels between the substance of the brain and the inner membrane. Hemorrhage is provoked by injury or a change in the thickness of the vessel walls. Often this type of pathology occurs in premature babies, during long labors with obstetric care. The symptoms will be as follows: the child’s eyes squint, and the head grows in size, the baby does not sleep, screams and lies with his eyes open, convulsions are possible. The clinical picture appears immediately after the baby is born or after a couple of days. If you start treatment right away, such a cerebral hemorrhage in newborns will not leave any consequences at all.

Subdural is a hemorrhage between the soft and hard membranes of the brain. The condition is provoked by the large size of the fetus, a protracted or rapid labor process. As the baby moves through the birth canal, the skull plates can become dislodged or damaged. This type of injury affects the brain, so the condition is fraught with neurological disorder. The sooner the pathology is detected, the better the prognosis.

How dangerous is a cerebral hemorrhage in a child?

The main complications after cerebral hemorrhages are paresis. The condition is characterized by damage to the motor pathways of nerve endings. A newborn may experience seizures, up to 15 seizures per day. The child needs to be monitored and registered with a medical institution; epilepsy will develop.

A complication of hemorrhage is hydrocephalus. This is an accumulation of fluid in the cerebral ventricles. As events develop, intracranial pressure increases, the child becomes restless, sleeps poorly and suffers from pain. The consequences of hydrocephalus are: cerebral palsy, epilepsy, delayed physical and intellectual development. Cerebral palsy occurs when one region of the brain is damaged, or when 2-3 parts are damaged.

The condition is characterized by impaired motor activity; 70% of patients have impaired intellectual abilities. The child will not be able to move without the help of other people, does not speak and cannot care for himself.

With any type of hemorrhage, this will affect the child’s behavior in the future. After hemorrhage, children may have difficulty falling asleep and waking up at night before the age of 3 years.

The baby cannot sleep, suffering from excitement. The appetite of such children is lower than that of others; there are no specific taste preferences. To provide the body of a growing child with all the nutrients, parents will need to stimulate appetite, give vitamins and mineral supplements, and introduce formulas specifically designed for such children into the diet. Compared to cerebral palsy, behavioral disorders and poor appetite do not seem such terrible complications, but they can also ruin a child’s life, so any complication deserves attention.

Forecast

For the most part, children who have suffered hemorrhage in the first days of life are characterized by excessive excitability, which affects their studies and communication with peers. Boys are usually aggressive towards adults and children around them, so it is important to provide timely psychological assistance in order to correct the child’s behavior and help him adapt to society.

In newborns, the brain is much better able to recover when compared with the adult brain. The recovery period after a hemorrhage can take from a couple of months to a couple of years. With timely diagnosis and proper treatment, serious consequences can be avoided. The prognosis varies depending on the degree of brain damage and the presence of other diseases.

Rehabilitation consists of taking medications, performing special exercises, monitoring by a neurologist and regular examinations. Parents' attentive attitude to the baby's health will save him from future problems.

To summarize, it can be noted that cerebral hemorrhage in newborns can have quite serious consequences. It is almost impossible to protect yourself from the pathology, but there is a chance to minimize the risk of its occurrence if you follow the doctor’s advice during pregnancy, and during childbirth you follow all the recommendations of obstetricians.

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

Causes

Hemorrhage in the tissue and membranes of the brain in an infant is caused by rupture of blood vessels. Such a pathological process may be a consequence of hypoxic damage or damage to the newborn’s skull during childbirth.

The prerequisites for hemorrhage are:

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

Classification

Depending on the area of ​​the brain where the blood vessels ruptured, there are:

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

Hemorrhages in the ventricles and brain matter usually occur in premature babies who have slow intrauterine brain development. The risk group includes babies born before 32 weeks of pregnancy.

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

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

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

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

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

The consequences depend on how quickly the injury is detected, its causes are determined and therapy is initiated. Subdural hemorrhages can lead to the development of neurological disorders and increased levels of bilirubin in the blood.

Subarachnoid hemorrhages – the most common type of hemorrhage in newborns. Such hemorrhages usually occur in premature infants when blood vessels are damaged in the space between the substance of the brain and the arachnoid membrane. They can be triggered by prolonged labor with obstetric intervention.

The following symptoms are characteristic of subarachnoid hemorrhages: constant crying, general agitation of the newborn, sleep disturbance, a wary, anxious expression on the child’s face, prolonged lying of the baby with his eyes open, a violent reaction to any irritant, tension in the neck muscles, an increase in head circumference, provoked by the divergence of the skull bones, convulsions, squint.

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

Treatment

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

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

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

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

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

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

Causes

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

One of the first reasons can be considered chronic fetal hypoxia during the week of pregnancy. The fact is that during this period the periventricular space is literally penetrated by a large number of vessels, which play an important role at this stage, but over time cease to be functional. If complications arise and there is a lack of oxygen during these weeks, hemorrhages may form, which will worsen during childbirth under the influence of mechanical pressure.

Other causes of cerebral hemorrhage are:

• lack of vitamin K and K-dependent factors, other anomalies associated with the coagulation process (blood clotting);
• pathologies due to severe hypoxia: acidosis, too strong activation of fat peroxidation, low blood pressure;
• intrauterine infections with viruses, mycoplasmas that contribute to the destruction of vascular walls;
• chronic maternal diseases (for example, diabetes);
• the influence of a woman’s harmful habits (tobacco smoking, alcoholism);
• injuries during childbirth due to the narrow birth canal and large fetal head, during rapid labor, caesarean section;
• use of obstetric aids (vacuum extraction of the fetus, obstetric forceps).

Types and extent of damage

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

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

Subarachnoid hemorrhage is said to occur when a vessel ruptures in the space between the arachnoid and soft membrane. If blood fills one or more ventricles, we are talking about intraventricular hemorrhage (hereinafter abbreviated as IVH). Another epithelial layer that protects the brain is called ependyma. Rupture of the vessel in this area leads to subependymal hemorrhage.

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

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

According to the ICD-10 classification, hemorrhages are divided as follows:

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

Various diagnostic formulations sometimes confuse the correct diagnosis, so when deciding on a treatment regimen, the doctor is guided by the results of an ultrasound, MRI or X-ray examination.

Signs of a brain hemorrhage do not always appear immediately. The pathology may be asymptomatic for the first day

Symptoms

The clinical picture, depending on the location of the vascular damage, will differ slightly, but in general, the characteristic signs of hemorrhage in an infant are identified:

• a sharp deterioration in condition, symptoms of hyperexcitability are replaced by signs of depression;
• the fontanel swells greatly and is tense;
• the strength and nature of the baby’s cry changes;
• seizure activity;
• peripheral circulatory disorders, rapid heartbeat, frequent regurgitation, weight loss, increased gas formation, shortness of breath, apnea;
• anemic syndrome, decreased hemoglobin in the blood;
• an increase in ketone bodies and bilirubin in the blood, which poisons the body with toxins;
• development of renal and cardiovascular failure;
• the addition of a secondary infection, as a result of which the development of sepsis, meningitis, and pneumonia is possible.

Now let us characterize the clinical picture in individual situations:

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

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

Intraventricular hemorrhage in newborns

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

All this occurs due to an increase in fluid volume, a sharp increase in intracranial pressure and, as a result, swelling of the brain and compression of the nerve centers responsible for various functions in our body.

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

Epidural and subdural

Simply put, it is a hematoma, a bag of accumulated blood between the skull and the dura mater. In children it develops due to mechanical pressure during childbirth. The symptoms have 2 phases: convulsions and a decrease in all reflexes and organ functions until loss of consciousness, then “clearance” occurs.

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

Subarachnoid

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

Diagnosis and treatment

The diagnosis is made based on the results of ultrasound examination through the fontanel and computed tomography, as well as based on blood tests.

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

Using CT, you can see the extent of hemorrhage and its location

If this treatment does not produce results, surgical intervention is indicated: bypass surgery.

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

Prevention

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

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

Hemorrhage in newborns

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

Causes of hemorrhage in newborns

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

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

• Prematurity or postmaturity;
• The baby’s head is too large and/or the mother’s birth canal is narrow;
• Intrauterine infections;
• Protracted or rapid course of labor;
• Obstetric interventions.

At the slightest suspicion of hemorrhage in a newborn, and this may include apnea, convulsions, disturbances of consciousness and neurological symptoms, a computed tomography scan of the baby’s head is performed.

Types and symptoms of pathology

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

Epidural hemorrhages are localized between the bones of the skull and the dura mater of the brain and can occur when the vault of the skull is damaged. In this case, characteristic signs will be dilation of the pupil of the eye from which the damage occurred, slow heart rate, low blood pressure, suffocation and convulsions. Typically, in the first 3-6 hours the baby behaves absolutely calmly, but then he shows signs of compression of the brain, which can lead to a coma within 24 hours.

Subdural hemorrhages in newborns are localized between the soft and hard membranes of the brain and are most often observed during prolonged labor of a large fetus due to displacement of the skull plates. Since modern methods of obstetric care can minimize such injuries, bleeding of this type practically does not occur today. It can have long-term consequences in the form of neurological disorders and high bilirubin levels, but timely treatment can avoid this.

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

Intraventricular hemorrhage in newborns occurs in cavities filled with cerebrospinal fluid, usually with severe prematurity and slow intrauterine growth, which is very likely during childbirth before the 32nd week of pregnancy.

Treatment of intracranial hemorrhage in a newborn

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

Consequences of hemorrhage in a newborn

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

Text: Marina Kudryavtseva

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

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

Intraventricular hemorrhages also occur in adults, representing a form of stroke with high mortality. As a rule, blood penetrates into the ventricular system from intracerebral hematomas when they break into the brain cavity.

Hemorrhage into the ventricles of the brain in children is usually isolated and 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 the pathology, because many drugs are contraindicated for babies, and immature nervous tissue is extremely sensitive to any unfavorable circumstances, but also to the prognosis, which cannot always reassure young parents.

In addition to children born during an abnormal course of the labor period, IVH is diagnosed in premature infants, and the shorter the gestational age 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 on the first day of life, up to 25% of IVH occurs on the second day after birth. The older the child, the lower the likelihood of circulatory disorders in the brain, even if the course of labor is abnormal.

Today, neonatologists have highly informative research methods in their arsenal that allow timely diagnosis of intraventricular hemorrhage, but problems with classification and determination of the stage of pathology have not yet been resolved. A unified classification of IVH has not been developed, and when formulating 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 reasons for the development of IVH in young children are fundamentally different from those that cause hemorrhages in adults. If in the latter vascular factors come to the fore - hypertension, atherosclerosis, which underlie strokes, and the 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 during childbirth;
• Injuries during obstetric care (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 considered to be the presence of the so-called germinal matrix, which should gradually disappear as the fetal brain and vascular system mature. If birth occurs prematurely, then the presence of this structure creates the prerequisites for IVH.

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

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 even a minimal volume of blood appears in the ventricle of the brain, we can talk about 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 determine the prognosis in the future, which depend on the amount of blood entering the ventricles and the direction of its spread towards the nervous tissue.

Radiologists base IVH staging on CT scan results. 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 moment a breakthrough of blood into the ventricles can occur.
• IVH grade 2 is a typical intraventricular hemorrhage without expansion of its cavity, when blood exits the subependymal space. On ultrasound, this stage is characterized as IVH with less than half the volume of the ventricle filled with blood.
• IVH stage 3 - blood continues to flow into the ventricle, filling more than half of its volume and expanding the lumen, which can be observed on CT and ultrasound.
• IVH of the 4th degree is the most severe, accompanied not only by the filling of the brain ventricles with blood, but also by its spread further into the nervous tissue. CT scan reveals 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 expanded, spontaneous cessation of bleeding is possible and normal liquor dynamics are maintained.
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 into the 3rd and 4th ventricles of the brain occurs in the second stage.
3. The third stage is accompanied by progression of the disease, blood entering the choroid of the cerebellum, medulla oblongata and spinal cord. The likelihood of fatal complications is high.

The severity of IVH and its manifestations will depend on how quickly blood penetrates the brain tissue and its cavities, as well as on its volume. Hemorrhage always spreads along the flow of cerebrospinal fluid. In very premature babies, as well as those who have suffered deep hypoxia, disorders of the blood coagulation system occur, so clots do not appear in the cavities of the brain for a long time, and liquid blood “spreads” unhindered throughout the parts of the brain.

The basis for the disorder of cerebrospinal fluid circulation 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 coagulate. Some of the liquid blood penetrates into other cavities of the brain, but as it coagulates, clots begin to block the narrow zones through which the cerebrospinal fluid circulates. Blocking any of the openings of the brain entails blockage of the cerebrospinal fluid pathway, dilatation of the ventricles and hydrocephalus with characteristic symptoms.

Manifestations of IVH 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 his weight, the higher the likelihood of pathology. After the first week of a child’s life, the risk of hemorrhage decreases significantly, which is associated with the adaptation of the vascular system to new conditions and the maturation of the structures of the germinal matrix. If a child was born prematurely, then for the first few days he should be under close supervision of neonatologists - on the 2-3rd day the condition may worsen sharply due to the onset of IVH.

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

A typical intracerebral hemorrhage is manifested by symptoms such as:

• Decreased muscle tone;
• Sluggish tendon reflexes;
• Breathing disorders up to stopping (apnea);
• Convulsions;
• Focal neurological symptoms;
• Coma.

The severity of the pathology and the characteristics of the symptoms are associated with the volume of blood entering the ventricular system and the rate of increase in pressure in the cranial cavity. Minimal IVH, which does not cause obstruction of the cerebrospinal fluid ducts 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 number in the baby’s blood.

An intermittent course is observed in moderate and submassive IVH, which are characterized by:

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

Symptoms with spasmodic flow are expressed over several days, after which they gradually decrease. Both complete restoration 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, bluish skin, bradycardia, decreased blood pressure, and thermoregulation disorders. Intracranial hypertension is indicated by 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. IVH in newborns may be indicated by a drop in hematocrit level, a decrease in calcium, fluctuations in blood sugar, and frequent blood gas disorders (hypoxemia) and 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 severe focal symptoms in the form of paresis and paralysis, sensory disturbances, and 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 are ischemic-hypoxic damage and residual changes in the brain in the form of cysts, periventricular leukomalacia, white matter gliosis, and cortical atrophy. By about a year, a developmental delay becomes noticeable, motor skills suffer, the child cannot walk or perform correct movements of the limbs in due time, does not speak, and lags behind in mental development.

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

IVH on a diagnostic image

Treatment and prognosis

Neurosurgeons and neonatologists treat children with IVH. Conservative therapy is aimed at restoring the functioning of vital organs and blood counts. If the child did not receive vitamin K at birth, it must be administered. Deficiency of coagulation factors and platelets is compensated by transfusion of plasma components. If breathing stops, artificial ventilation of the lungs is performed, but it is better to arrange it as planned if there is a risk of respiratory disorders.

Drug therapy includes:

• Normalization of blood pressure to prevent sharp decreases or surges that aggravate hypoxia and damage to nervous tissue;
• Oxygen therapy;
• Anticonvulsants;
• Blood clotting control.

To reduce intracranial pressure, the administration of magnesium sulfate intravenously or intramuscularly is indicated; diacarb, furosemide, and veroshpiron are used for full-term children. Anticonvulsant therapy consists of prescribing diazepam and valproic acid drugs. To relieve symptoms of intoxication, infusion therapy is carried out; acidosis (blood acidification) 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 through their puncture under ultrasound control, introduction of fibrinolytic agents (actelyse) into the lumen of the ventricles to prevent thrombosis and occlusive hydrocephalus. It is possible to combine puncture with the administration of fibrinolytic drugs.

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

In case of blockage of the cerebrospinal fluid ducts and hydrocephalus 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 tract 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 catheter for ventricular drainage

If hydrocephalus has become persistent and irreversible, and there is no effect from fibrinolytic therapy, then neurosurgeons provide permanent drainage surgically:

1. Installation of permanent shunts with the outflow of cerebrospinal fluid into the abdominal cavity (a silicone tube passes under the skin from the head to the abdominal cavity, the shunt can be removed only if the child’s condition has stabilized and hydrocephalus has not progressed);
2. Endoscopic anastomosis between the ventricles of the brain and the basal cistern.

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

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

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

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

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

If the baby is still born prematurely, he is placed in the intensive care unit for observation and treatment. Modern methods of diagnosing and treating IVH can not only save babies’ lives, but also significantly improve their quality, even if this requires surgery.

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

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

Features and risk factors

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

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

1. Premature birth (before 32 weeks), especially if the pregnancy was accompanied by prolonged toxicosis.
2. Rapid or prolonged labor, which is considered pathological and causes brain hypoxia in the fetus.
3. The use of obstetric forceps, which damage the baby's skull.
4. Post-term pregnancy. In this condition, the baby’s skull bones lose elasticity, increasing the risk of injury during childbirth.
5. Damage to intrauterine infection.
6. The fetus is too large for a woman with a narrow pelvis.
7. Various defects in children.

Remember! Premature babies have a 50% risk of birth injury with subsequent intracranial hemorrhage. The highest probability of pathology is in children weighing less than 1.5 kg.

Types and symptoms of cerebral hemorrhages

Common signs of cerebral hemorrhage in children are:

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

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

This pathology has the following varieties:

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

Important! The most dangerous period is considered to be the first week after the birth of a child, when the initial symptoms of hemorrhage are detected. If no deterioration is observed after the second week of the baby’s life, then the prognosis becomes more favorable.

Diagnostics

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

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

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

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

Treatment

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

The acute period of the disease requires restoration of the functions of the brain, heart and breathing. The general course of therapy is aimed at normalizing blood circulation.

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

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

A puncture is performed to reduce intracranial pressure.

In case of severe bleeding, Vikasol or calcium chloride are prescribed.

To restore important microelements in the body, the course of treatment includes Glucose, Sodium Sulfate, Panangin.

To help their child, parents should follow these tips:

• do not self-medicate and immediately agree to hospitalize the baby;
• Continue breastfeeding for as long as possible;
• carry out all medical appointments;
• carry out the necessary hygiene measures for the newborn;
• do not leave crying unattended.

Possible complications

The baby’s brain has excellent recovery abilities, so with minor pathology, the baby’s prognosis is favorable, and he will be able to develop normally. The recovery process takes from 5 months to 2 years.

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

• epilepsy;
• developmental disorder;
• neurological disorders;
• death.

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

Rehabilitation

In the first days after the pathology is detected, the child should be under constant medical supervision. Usually such babies are transferred to intensive care.

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

In the first week, the newborn should be fed breast milk. If swallowing function is impaired, a probe is inserted.

When the child’s condition normalizes and after the end of drug therapy, a rehabilitation course should be carried out. It includes massage and special gymnastics. As your child gets older, he or she may need swimming lessons and speech therapy.

Also, such patients must be regularly observed by a doctor (pediatrician, neurologist, orthopedist).

Preventive measures

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

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

1. Be periodically observed by a doctor throughout your pregnancy.
2. Take care of your health and avoid stress.
3. Refuse from difficult physical work that can cause premature birth.
4. Treat infectious diseases that can harm the fetus and cause complications in a timely manner.
5. Give up bad habits (smoking, drinking alcohol) and stick to proper nutrition.
6. Carefully choose clinics and the doctor who will deliver the baby.

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

Brain hemorrhage in a newborn is considered a very dangerous pathology that must be responded to immediately. Even if parents notice signs of brain damage after being discharged from the hospital, they should consult a doctor as soon as possible to be able to prevent serious complications.