Intracranial hemorrhage in newborns. Causes and treatment of cerebral hemorrhage in newborns

The birth of a child is probably the most anticipated event for a pregnant woman. But sometimes it happens that childbirth occurs with some complications that can affect both the mother and the child. Birth injuries are very dangerous. In this article we will look at one of the possible birth injuries- intracranial hemorrhage.

Bleeding in the brain occurs due to a violation of the integrity of blood vessels inside the skull of a newborn baby. They can be both superficial and deep. Damage varies in size and location.

Causes of cerebral hemorrhages

Factors that provoke cerebral hemorrhage include:

Early or late birth.
Discrepancy between the birth canal and the volume of the newborn’s head.
Too fast or, conversely, prolonged labor.
Difficult pregnancy.
Erroneous actions of obstetricians.

It should be noted that about half of premature babies are born with this pathology, while in those born on time, hemorrhage occurs in one case out of a thousand.

Types of damage: what awaits after a newborn

Symptoms and consequences of hemorrhages different localization have obvious differences. Medicine identifies the following foci of localization of intracranial flow, for example, trauma to the blood vessels between the bones of the skull and the dura mater causes epidural hemorrhage. Occurs when there is damage to the cranial vault. The symptoms are as follows:

difficulty breathing;
convulsions;
low blood pressure;
decreased heart rate;
damaged eye pupil on the same side in which the hemorrhage occurred.

The first few hours the child is relatively calm. After 3-6 hours, cerebral compression syndrome occurs. The newborn's condition deteriorates sharply. Coma may occur within 2-3 days. The consequences are sad, since medicine is basically powerless.

There is also trauma to the vessels that are located between the inner and outer membranes of the brain, which leads to subdural hemorrhage. High probability displacement of the skull plates.

Clinical picture and consequences of pathology

Previously, the pathology was quite common, especially during rapid labor. But with the improvement of the technical equipment of hospitals this type injuries have become quite rare. As a consequence of the pathology, there is an increase in the level of bilirubin in the blood, as well as a tendency to neurological diseases.

Violation of the integrity of the blood vessels between the pia mater and the cobweb of the brain provokes subarachnoid hemorrhage in newborns. Characteristic of long, difficult labor. Symptoms:

high excitability of nervous processes;
sleep disturbance;
convulsive attacks;
anxiety, irritability and constant crying of the newborn;
it is possible to increase the volume of the head.

Due to the presence of blood in the lining of the brain, acute inflammatory process. The consequences are usually not serious and are relatively easily tolerated by the body.

Entry into the spinal ventricles

Blood entering the spinal ventricles is called intraventricular hemorrhage. This pathology is typical for premature babies or for newborns with a malformation of the brain.

Clinical picture and consequences of pathology:

In most cases, the hemorrhage stops on its own and does not cause serious consequences. But in case severe damage vessels and a large volume of blood entering the ventricles, everything does not go so smoothly. Necessary timely treatment, otherwise complications are possible in the form of problem behavior and, in as a last resort, cerebral palsy.

Hemorrhage directly into the brain tissue is called intracerebral. In this case, the part of the brain that was damaged due to hemorrhage ceases to perform its functions. Symptoms depend on the area of the brain affected.

Main symptoms

All types of hemorrhages have some common features:

inhibition of reactions and mental processes;
lack of activity;
convulsions;
sleep and appetite disorders.

If you observe a sudden onset in a newborn similar symptoms, you should consult a doctor immediately. The pediatrician will prescribe necessary complex treatment, including surgery and restorative therapy. Timely diagnosis and therapy for cerebral hemorrhage minimizes negative consequences.

Brain hemorrhage in newborns - serious pathology, developing as a result of damage to the vessels of the dura mater or rupture of a cerebral vessel. This often happens with. 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, general condition infant and compensatory abilities of the brain.

Reasons

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 hypoxia fetus at 26-34 weeks of pregnancy. The fact is that during this period the periventricular space is literally permeated a large number vessels playing at this stage important role, but over time they cease to provide functionality. If complications occur and there is a lack of oxygen during these weeks, hemorrhages may form, which will worsen during childbirth under the influence of mechanical pressure.

Other causes of cerebral hemorrhage are:

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);
influence bad habits women (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 vessels and lymphatic vessels, small and large, delivering oxygen to it and protecting 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're talking about 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 cause confusion correct diagnosis Therefore, when deciding on a treatment regimen, the doctor is guided by the results of an ultrasound, MRI or X-ray examination.

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

Symptoms

The clinical picture will differ slightly depending on the location of the vascular damage, but in general, characteristic features hemorrhages in infants:

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;
violations peripheral circulation, rapid heartbeat, frequent regurgitation, weight loss, increased gas formation, shortness of breath, apnea;
anemic syndrome, decreased hemoglobin in the blood;
increase in blood ketone bodies, bilirubin, 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's characterize clinical picture in specific situations:

SEC

One of the most common forms of hemorrhage. Some kind of special specific symptoms SEC does not have. 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 eyeballs and in symptoms of depression/arousal in mild degree. As a result of SEC, a cyst often forms.

Intraventricular hemorrhage in newborns

For hemorrhage in the ventricles of the brain of 1st and 2nd severity visible symptoms are absent and may pass without development neurological pathologies. However, in more severe cases, swelling of the fontanelles, convulsions, disruptions in breathing and cardiovascular system. Then lethargy sets in, reflexes are suppressed and motor activity, the head may increase in size.

All this occurs due to an increase in liquid volume, sharp increase intracranial pressure and, as a consequence, cerebral edema and compression nerve centers, responsible for various work 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. The first 2-3 days nothing visible violations there may not be. 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 ultrasound examination through the fontanel and computed tomography, and also judging by blood tests.

Treatment acute phase held in special conditions while maintaining the required temperature regime 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 give results, shown surgery: shunting.

Separately, I would like to say about hemorrhage in the adrenal glands in newborns. In severe hypoxia or improper management of labor, adrenal hemorrhages are possible, which, if not treated in time, lead to fatal outcome. When found similar pathology treatment is aimed at compensating for adrenal hormone deficiency, increasing blood pressure, antishock 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.

Brain hemorrhage in a newborn, also known as intracranial hemorrhage, is caused by ruptured blood vessels inside the skull. This may be the result of a lack of oxygen or bone deformation during childbirth. Cerebral hemorrhage is more common when there is ischemia - insufficient blood flow to the brain, as well as hypoxia - a decrease in the amount of oxygen in the blood.

Most infants with intracranial bleeding do not experience any symptoms. But this condition can lead to slowness, lethargy and problems with feeding. Depending on where the cerebral hemorrhage occurred in a newborn, it is classified into several types.

Brain hemorrhage in a newborn is diagnosed through ultrasound. All infants with intracranial hemorrhage should receive intensive care, as well as treatment with intravenous fluids and other treatments to support body functions until the body recovers. For subdural hemorrhages, therapy should be performed by a surgeon. At proper care and treatment, intracranial bleeding does not cause long-term problems. Although the result depends on many factors, including the extent of the disease, the degree of brain damage, and other diseases and infections the child has. To ensure that a newborn with a cerebral hemorrhage can develop to his or her maximum potential in the future, parents should provide a stimulating environment during the early years of life.

Intraventricular hemorrhage (IVH) is a pathology in which small vessels burst and bleed into the ventricles of the newborn baby's brain.

Ventricles are cavities in the brain that are filled with cerebrospinal fluid ( cerebrospinal fluid). A person has several of them and they are all connected to each other.

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

Hemorrhage does not appear just like that; there must be reasons for this disorder.

Who is at risk?

Brain hemorrhage in newborns can be associated both with damage to the skull itself and with a lack of oxygen.

Prerequisites for DRC:

Post-term or, conversely, under-term. Premature babies are especially susceptible to intracranial hemorrhages, since their immature vessels do not yet have sufficient support in the tissues. In children born late, the bones become denser and the head is unable to adjust during childbirth. According to statistics, IVH occurs in every fifth premature baby and every tenth post-term baby.
The size of the fetal head does not correspond to the size of the birth canal. In this case, natural delivery is contraindicated, because it is fraught with injury and hypoxia for the newborn baby.
Difficult pregnancy(fetal hypoxia, intrauterine infection with various infections).
Difficult (protracted or rapid) labor, breech presentation.
Incorrect actions of obstetricians during childbirth.

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

The risk of cerebral hemorrhage in a child increases with:

prematurity;
low birth weight (less than 1.5 kg);
oxygen deficiency (hypoxia);
head injury to the child during childbirth;
breathing complications during childbirth;
infections leading to blood clotting disorders.

If the child belongs to at least one of these groups, it is necessary to find out whether he has symptoms of intracranial hemorrhage.

Characteristic symptoms

Not always there visible signs hemorrhages. Also, if a child has any of the symptoms listed below, then it is not at all necessary that this is due to IVH; they can also be caused by other diseases.

The most common symptoms of intraventricular hemorrhage in infants:

In premature infants, IVH manifests itself as a sharp and rapid deterioration of the condition on the second or third day after birth.

Severity

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

It is possible to establish one or another degree of hemorrhage only with the help of a special study.

Diagnostic methods and criteria

For diagnosis in the presence of corresponding symptoms, it is usually used (using sound waves vascular ruptures and bleeding are determined). Blood tests are also taken to check for anemia, metabolic acidosis, and infections.

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

Possibilities of modern medicine

If a child is found to have hemorrhage in the ventricles of the brain, he should be under the vigilant supervision of medical staff. The baby's condition is monitored to ensure his stability.

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

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

Ventricular(through the fontanel) or (through the lower back) punctures.
when a special drainage tube is inserted into the ventricles. It stretches under the skin to abdominal cavity patient, where excess cerebrospinal fluid is absorbed. The drainage system must remain in the body at all times, and the tube must be replaced if necessary.

It should be noted that for most patients (at 1 and 2 degree of IVH) any therapy is not required at all, you can count on a favorable outcome.

Be careful, video of the operation! Click to open

Prognosis depending on the degree of hemorrhage

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

Preventive measures

It is impossible to prevent hemorrhage in the baby’s brain one hundred percent, but some measures can and should be taken to reduce the risk.

Correct determination of delivery tactics

Often perinatal intracranial hemorrhages occur due to birth injuries, so it is extremely important to carefully assess the relationship between the mother’s pelvis and the fetal head.

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

In addition, in this case it is assigned special therapy(corticosteroids, immunoglobulin, platelet mass). During childbirth, it is important to monitor the baby's blood pressure and avoid fluctuations in order to cerebral blood flow did not intensify.

Prenatal screening

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

In addition, you should know that intracranial hemorrhages are possible not only in newborns. They can occur as a result of injury at absolutely any age.

Hemorrhage in the brain is a rupture of pathologically altered walls cerebral vessels located inside the skull or in the space between the cranial vault and the dura mater. Pathology most often appears as a result of errors medical personnel admitted in the process of providing obstetric care during labor activity, but sometimes the cause of intracranial bleeding can be a complicated course of pregnancy or a woman’s failure to comply with recommendations on the regimen (for example, lack of long walks and fetal hypoxia developing against this background).

The consequences of cerebral hemorrhage for a newborn can be very dangerous, since it is the rupture of cerebral vessels that leads to the occurrence of cerebral palsy. However, the prognosis can be quite favorable if the problem is detected in a timely manner and proper treatment and care.

Pathological changes in the blood vessels of the brain often develop with a lack of oxygen, so it is recommended for a pregnant woman to undergo fresh air as much time as possible. In some cases, fetal hypoxia may be the result of a violation metabolic processes in the body of a woman or child. Pathologies in the formation and functioning of the placenta (for example, premature aging) lead to insufficient supply of oxygen and nutrients, which is a risk factor for intracerebral hemorrhage.

Acute hypoxia can also occur during prolonged and difficult labor. Great danger represents misdiagnosis size and weight of the fetus: if the circumference of the baby’s head is wider than birth canal mother, the baby may become stuck and suffocate. In this case, the doctor decides to apply obstetric forceps or using a vacuum. These procedures are also quite dangerous, since when the head is strongly compressed, the blood vessels of the brain are compressed, which, under the influence high blood pressure may burst.

Pay attention! Bleeding in the brain during the application of obstetric forceps is diagnosed in 42% of babies, so during pregnancy it is important to undergo medical examinations prescribed by the doctor on time to exclude complications during labor. If there are significant risk factors, the woman will be offered fetal extraction using caesarean section, which will reduce the likelihood of negative consequences.

Doctors include other causes of cerebral hemorrhages in newborns:

premature, rapid labor;
childbirth after 40 weeks of gestation;
maternal infections during pregnancy.

Infectious diseases of the mother during pregnancy, such as sexually transmitted infections, have a very negative effect on the condition of the fetus and its development. Vascular damage can occur even during intrauterine growth Therefore, a woman should be attentive to her own body and take all measures to prevent infectious diseases.

Types of bleeding

To determine the prognosis of life and health, it is necessary to correctly classify the type of hemorrhage. The types of pathology differ in location and causes, and their diagnosis can provide a more complete clinical picture and determine treatment tactics.

Type of hemorrhage	Symptoms	Location of blood vessel damage	Causes	Possible consequences
Epidural	Difficulty breathing low frequency pulse, decreased pressure, dilated pupil from the pathological process	The space inside the cranium and between the skull and hard meninges	Rapid labor, birth at 41-43 weeks, underdevelopment of the skull bones during intrauterine growth	Cerebral compression syndrome (manifests 4-8 hours after birth), coma on days 2-3
Subdural	The accumulation of blood occurs between the soft and hard shells brain	Weakness or complete absence innate reflexes(for example, sucking reflex), muscle weakness(hypotension), seizure syndrome	Discrepancy between fetal weight or head circumference and maternal pelvic size	Neurological disorders, cerebral palsy
Ventricular	Left and right ventricles of the brain	Muscle weakness, lack of vital reflexes, frequent stoppage of breathing	Premature birth, intrauterine development disorder	Cerebral palsy and coma
Subarachnoid	The space under the meninges, the substance of the brain	Increased excitability, difficulty falling asleep, anxious facial expressions, squint, unnaturally long periods of wakefulness for a newborn, squint	Prematurity, use of instruments (forceps or vacuum) during delivery	Irregularities at work nervous system

Important! Subarachnoid hemorrhage has the most favorable prognosis. If provided in a timely manner medical care and proper care, the child’s brain will recover in a few months. The most dangerous is hemorrhage into the ventricles of the brain. This type of brain bleeding has the highest mortality rate and unfavorable life prognosis.

Possible consequences

The most common complications of cerebral hemorrhages are neurological pathologies, for example, paresis. This is a decrease in strength caused by defeat motor pathway nervous system. Simultaneously with paresis, the child may experience involuntary muscle contractions - cramps. With severe disorders, their number can reach 15-20 attacks per day. Child with convulsive syndrome must be under constant medical supervision and be registered with a specialized medical institution. It is possible to develop epilepsy - chronic neurological disorder, in which a person is prone to frequent attacks seizures

One more thing possible complication– hydrocephalus of the brain. It is an accumulation of fluid in the ventricles of the brain. At the same time, the newborn increases intracranial pressure, increased anxiety appears. Such a child has difficulty falling asleep and wakes up quickly, as he experiences severe headaches due to constant pressure fluid on the cerebral hemispheres. The consequences of hydrocephalus can be:

epileptic disorders;
cerebral palsy;
retardation in physical and mental development.

Cerebral palsy in a newborn can occur both when several parts of the brain are damaged, and when the functioning of one lobe is impaired. With this disease, the child’s motor activity is impaired. In 70% of cases there is an intellectual disability. Such a child most often cannot move without outside help, does not speak and does not have basic self-care skills.

Changes in behavior

Any form of hemorrhage can affect behavioral characteristics older child. Children who have suffered intracranial bleeding in the first day of life may have difficulty falling asleep. At the age of 1-3 years, such children often wake up at night, and some may experience hallucinations. If a child wakes up at night, he cannot fall asleep for a long time, experiences a feeling of anxiety and inexplicable excitement.

The appetite of such children is often reduced, but they do not have a passion for any particular dish. In the first year of life, parents may encounter problems with feeding and introducing complementary foods. To control the child’s appetite and provide his body with the necessary nutrients may require continuous use multivitamin preparations And mineral supplements, as well as the introduction of specialized formulas into the diet for children with developmental delays or poor appetite.

Important! Most children who have suffered a cerebral hemorrhage suffer from increased excitability, which affects their learning and relationships with peers. Some children (mostly boys) may show aggression towards surrounding children and adults. In such a situation, the child will most likely need the help of a psychologist or psychotherapist.

Hemorrhage in the brain - dangerous pathology, from which it is almost impossible to defend, therefore expectant mother should take maximum care of her own health during pregnancy and undergo all examinations prescribed by the doctor. During childbirth, it is necessary to listen to the instructions and advice of the midwife to avoid complications and the need to use instrumental methods obstetrics.