Hemorrhage into the ventricles of the brain in newborns. Consequences of intracerebral hemorrhage in newborns

Brain hemorrhage in newborns is the result of a rupture of an intracranial vessel. This is a serious injury that affects the development of the child, after which many complications are possible. Hemorrhage occurs for the following reasons - early birth, difficult pregnancy, incorrect obstetric care measures. The consequences depend on the location and extent of spread, but are unfavorable.

The brain consists of 3 membranes - hard, soft and arachnoid (arachnaid), and according to its internal structure it contains the ventricles, white and gray matter of the brain. Shells perform a protective and conductive function. Together they form the BBB - the blood-brain barrier, which is responsible for protecting the brain from blood cells, viruses and bacteria.

In order, starting from the cranial vault, the brain is covered on top by the dura mater. In Latin it is called “dura mater”, because the bleeding between the skull and the dura mater is called epidural, and under the dura mater - subdural bleeding.
The next shell is the arachnoid. Beneath it was a mass of cerebrospinal fluid. Another name is arachnoid.
After it comes the “pia mater” - the soft membrane is adjacent to the brain along its entire length, performing a protective function.
The brain is also lined with ependyma, an epithelial layer that envelops the brain and performs a protective function.

The membranes are penetrated by blood and lymphatic vessels. Gray matter performs an analytical function. It is located in the cerebral cortex and contains nuclei - clusters of neurons responsible for various functions of the body. The white consists of axons and dendrites of nerve cells and performs a conducting function. The ventricles serve as reservoirs of spinal cerebrospinal fluid, after which it spreads along the spinal cord canal and serves a homeostatic function.

Types and degrees of hemorrhage in children

The severity depends on the location of the hemorrhage. The following types of hemorrhages are distinguished:

Epidural;
Subdural;
Subarachnoid
Ventricular

Hemorrhages have 4 degrees of severity, depending on the distribution of blood in the brain and the extent of the lesion:

1st degree – subependymal hemorrhage;
2nd degree - blood partially or completely filled the lateral ventricle of the brain without increasing its size;
3rd degree - blood filled the ventricle and increased its size;
4th degree - the blood expanded the ventricle and penetrated into the substance of the brain.

This division is not entirely correct, since by their definition they do not reflect the massiveness of the hemorrhage, the degree of damage to the vessels and tissues of the telencephalon. ICD-10 suggests a different classification based on the extent of the lesion. ICD-10 is an international classification of diseases that systematizes data on diagnoses that are made today. This is what is indicated in the electronic journal of the disease.

Hemorrhages according to ICD-10:

Subependymal;
Intraventricular without breakthrough into the brain parenchyma;
Intraventricular with a breakthrough into the brain parenchyma.

The division introduces confusion into the formulation of the exact formulation of the diagnosis, therefore, when assessing the condition, it is worth relying not on them, but on ultrasound and radiography data.

Symptoms

Depending on the type of hemorrhage that occurred, symptoms vary. Symptoms vary in distribution between tissue layers and degree of penetration.

Epidural

Symptoms of epidural hemorrhage:

On the damaged side there is a visible dilation of the pupil;
– decreased heart rate;
Reduced blood pressure;
Hypoxia, or suffocation;
Muscle cramps.

Epidural bleeding is a consequence of damage to the calvarium. Premature babies especially often have a skull that is too plastic, which easily moves. The vessels are disrupted between the dural and bony layers, leading to the release of blood under the skull.

Symptoms do not appear for the first 4-6 hours, after which the child suddenly becomes worse. Two days - and the consequences are irreversible.

Symptoms of subdural hemorrhage: in general, the symptoms are the same as epidural hemorrhage, with the difference that there is no compartment syndrome. Such hemorrhage almost never occurs in medical practice at the moment due to improved obstetric techniques.

Subarachnoid

Signs of subarachnoid hemorrhage:

Excitability of the child;
Sleep disturbance, constant screaming;
An increase in the size of the head due to divergence of the skull bones;
Strabismus, convulsions;
Lying down with your eyes open.

This is a consequence of rupture of blood vessels under the arachnoid membrane of the brain. Blood breakdown products settle on the cortex and cause inflammation. Subarachnoid hemorrhage is a consequence of obstetric intervention, and it is the most dangerous.

Parenchymal and intraventricular

Symptoms of parenchymal and intraventricular hemorrhage. When blood fills the ventricles, everything will depend on the degree of their filling. Hemorrhage occurs in premature infants who have delayed central nervous system development and are born before 32 weeks. If the ventricles are not completely filled and are not enlarged in size, then the lesion goes away on its own after 3-4 days.

When the ventricles are completely filled and spread into the brain, if treatment was started too late, mental abnormalities will subsequently develop, the signs of which appear much later.

Causes

The causes of cerebral hemorrhage are quite extensive. Each individual case can have its own reasons, however, in most cases the following list is observed:

Fetal hypoxia due to smoking;
Prematurity;
Doctors' mistakes during childbirth;
Intrauterine infections.

The main reasons are prematurity and underweight. With underdevelopment in premature babies, the skull has an insufficiently strong structure. Even with proper obstetric care, hemorrhage is possible. Treatment in this case is accompanied by surgical actions to support the development of an underweight baby. The reasons are also related to the incorrect actions of obstetricians during childbirth.

Too long a labor can lead to occlusion of only the functioning vessels, which, with the first inhalation - the arrival of the first sips of external oxygen, will most likely burst and fill the spaces around.

In premature babies, such risks are doubly increased due to vascular weakness and an underdeveloped central nervous system. Smoking causes an increased intake of carbon dioxide into the blood, which prevents sufficient oxygen from reaching the fetal cells. Lack of energy during plastic metabolism causes a functional restructuring of brain cells and blood vessels. The blood vessels become weaker, and the central nervous system has developmental abnormalities.

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:

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

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.
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.
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 prescriptions,
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:

Be periodically observed by a doctor throughout your pregnancy.
Take care of your health and avoid stress.
Refuse from difficult physical work that can cause premature birth.
Treat infectious diseases that can harm the fetus and cause complications in a timely manner.
Give up bad habits (smoking, drinking alcohol) and stick to proper nutrition.
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 newborns is a serious pathology that develops as a result of damage to the vessels of the dura mater or rupture of a cerebral vessel. This often happens with birth injuries. According to statistics, intracranial hemorrhage (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 at 26-34 weeks 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:

SEC

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.

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

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

epidural;
subarochnoid;
subdural;
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.

With epidural hemorrhage, the cardiac and respiratory activity of the newborn decreases

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.

Cephalohematoma in a newborn due to hemorrhage (more details in the article:)

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.

With hemorrhage in the deep layers of the brain, the eyes may not react to light

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.

With hemorrhage in the deep layers of the brain and cerebellum, a coma may occur

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.

With an integrated approach to treatment, courses of massage treatments are prescribed

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.

Brain hemorrhage- this is the flow of blood from an injured vessel into the skull and gray matter of the brain, in which quite serious damage to internal tissues and organs is diagnosed, with subsequent disruption of the entire functionality of the body.

This is mostly due to injury to the child’s skull and brain during childbirth, although damage can also be caused by medical negligence, prematurity, or, conversely, postmaturity of the fetus. Same thing effusion of blood can enter the brain in any zone.

Types of cerebral hemorrhage in an infant

In accordance with the classification given by WHO, blood effusion into the brain is divided into 4 subsequent species that are determined by their own location.

Epidural

In this case there is hemorrhage, formed from a damaged vessel and located between the skull and the outer shell of the gray matter. Such bleeding can occur due to head injuries, including during labor of the mother and the birth of the child, household injuries and injuries.

If this type of hemorrhage is diagnosed in a child:

pupils will dilate and, as a rule, in the eye on the side of the injury;
decrease in rhythm hearts;
breathing problems, up to attacks of suffocation and convulsive contraction of muscles.

Feature of this hemorrhages there is that the symptoms will not manifest themselves immediately, but 5-6 hours after the vascular rupture occurs. If effective treatment is not prescribed in a timely manner, the patient’s condition will deteriorate sharply, the baby may fall into a coma - this is the most severe of all types of hemorrhage.

Subdural

In this case, the focus of localization bleeding There is an area between the soft tissues and the dura mater of the brain - often the root cause is too long a labor or, conversely, a rapid resolution of labor.

Thus, during the passage of the birth canal, the bones of the baby’s skull can injure the vascular network - as a result, there is a load on the gray matter and, as a result, extensive disorders neurological theology.

Subarachnoid

This type of hemorrhage in children is diagnosed more often– in this case, the vessel bursts and blood flows out between the inner membrane and the gray matter of the brain.

The cause of the development of this pathology may be thinning vessel or an injury - it is most often diagnosed in a premature baby, especially if the labor of the mother herself was prolonged and obstetric care was provided. When diagnosing this type of hemorrhage, the entire remaining product of blood breakdown leads to inflammation of the lining of the brain.

This pathology can manifest itself in the following ways:

baby doesn't sleep and always lies with his eyes open;
for any stimulus in the form of sound or noise, light reacts with screams and crying.

If there was subarachnoid hemorrhage, then the baby:

head will increase in size;
can cross your eyes and move involuntarily;
muscles the back of the head will be noticeably tense;
frequent attacks of muscle cramps.

Negative symptoms can manifest themselves both immediately after the baby is born and 2-3 days after birth. With timely, prompt diagnosis and treatment, the pathology is successfully eliminated and does not lead to the development of negative consequences.

Hemorrhage into the brain and ventricles

In this case blood gets directly into the tissues and the gray matter of the brain itself, as well as into the space between the ventricles and brain cavities. Such hemorrhage is most often diagnosed in a very premature baby born before the 32nd week of pregnancy whose brain is underdeveloped.

Causes and symptoms

For the most part, doctors diagnose cerebral hemorrhage in underdeveloped children - according to statistics, in newborns born with overweight up to 1.5 kg a similar pathology was diagnosed in 50% .

If the child is full-term, normally developed and formed, then, according to medical statistics, pathology manifests itself only in one case in every thousand newborns. Quite encouraging statistics.

Speaking about the root causes themselves, which can lead to hemorrhage in the brain and gray matter, for the most part doctors identify the following among them:

severe prematurity in the womb or vice versa– postmaturity of the fetus, prolonged intrauterine development;
if the pregnancy proceeded with a certain pathology– there was intrauterine infection or hypoxia or another reason;
large fetal head, which does not correspond to the size of the birth canal and during the birth process, the bones of the skull were displaced and thus injured the vessels of the head;
childbirth is too rapid in time or vice versa– prolonged delivery, when the fetus may experience oxygen starvation and increased intracranial pressure, leading to rupture of blood vessels;
incorrect, unqualified actions of a doctor– a gynecologist, obstetrician during childbirth, when doctors could strongly pull the fetus when leaving the birth canal or otherwise damage the head;

In any case, whatever the root cause, the main thing is in a timely manner diagnose cerebral hemorrhage and begin a course of effective and adequate treatment. In terms of signs, the symptoms of the pathology will be discussed below and depend on the location of the hemorrhage.

Degree of development of pathology

According to the classification, which is accepted by all doctors and approved by the World Health Organization, cerebral hemorrhages are conventionally divided into 3 degrees, although some authors of scientific works distinguish them in practice into 4 - these are the ones we will consider:

first degree– when diagnosing this degree of hemorrhage, it is worth saying that the lesion is limited in its volume only to the wall of the ventricles, where blood will not flow into their cavity itself.
second degree. In this case, blood during hemorrhage will directly enter the cavity of the ventricles of the brain.
third degree. In the third degree, blood will penetrate into the lateral ventricles and the spaces between them, when blood elements will be visible during MRI studies. Most often, in such cases, surgical intervention is prescribed and the result will directly depend on the degree of brain damage, as well as the development of hydrocephalus.
fourth degree. When diagnosing grade 4, hemorrhage will be diagnosed in the lateral ventricles, as well as in the gray matter of the brain.

Depending on the size of the hemorrhage, doctors can divide it into:

light form when the hemorrhage has a size of 0.5 to 1 cm;
average– the size of the hemorrhage varies from 1 to 1.5 cm;
severe degree– in this case, the hemorrhage is more than 1.5 cm in size.

Symptoms

Most often, hemorrhage occurs suddenly, and the clinical manifestation of the pathology will directly depend on the volume of blood, as well as the location of the hematoma and the type of its formation:

Why is hemorrhage dangerous?

When talking about the danger that this pathology poses to a child, it is worth taking into account the degree of damage - the brain is distinguished by such an amazing ability recover on your own.

Due to this peculiarity, it is enough to note that with a slight outpouring of blood, many children have an excellent chance of a successful recovery with properly prescribed treatment. But the process itself can take a long time - from 4 months to several years.

But with regard to the more severe manifestation of pathology, the prognosis for cerebral hemorrhage is very disappointing. If there is very serious brain damage, the pathology can lead to delays in the child’s development, cerebral palsy, epileptic seizures and hydrocephalus, as well as death.

Treatment

Exclusively medic can prescribe a course of treatment and in this case it is enough to understand that there is no single scheme and method of treatment. The course of treatment is tailored to the course of the disease, the degree of brain damage and existing symptoms. The main task is to restore the normal functioning of the central nervous system and heart, normalize the functioning of the adrenal glands and blood flow.

The course of treatment itself includes:

In any case, such a baby needs careful care and prevention - in this case, it is worth excluding any possibility of injury and bleeding, factors that can cause complications. A course of medications that improve metabolic processes in the brain may also be prescribed - such drugs may be Cerebrolysin, Aminalon.

The child is required to:

prescribe several courses of therapeutic massage and gymnastics– they will improve blood flow and the state of the central nervous system.
A course of sessions with a speech therapist is also prescribed. for older children.

In any case, upon discharge from the maternity hospital, such babies are registered with such highly specialized doctors as a neurologist and an orthopedist.

Consequences

If the child has:

Massive hemorrhage was diagnosed, accompanied by rupture of the tentorium cerebellum or falx - this leads to an immediate deterioration in health, as well as death almost immediately after birth.
If there is a massive effusion of blood into the brain, in particular, when its localization is the cerebral cortex, huge hematomas can occur, which then resolve and leave behind a porencephalic cyst.
If intraventricular hemorrhage occurs, then the consequence is dilation of the ventricles, then in 80 percent the pathology does not cause posthemorrhagic hydrocephalus. This diagnosis develops only in 10-13% of all babies who have suffered an outpouring of blood into the ventricles.

At first, negative symptoms may not manifest themselves, showing symptoms such as rapid head growth, depression of the central nervous system and swelling of the fontanelle, and dehiscence of the skull only after 3-4 weeks. In 6 out of 10 cases, posthemorrhagic hydrocephalus stops growing or the development process reverses.

21.09.2016