Causes of subarachnoid hemorrhage in a premature baby. Brain hemorrhage in newborns - about causes, treatment and prevention

Cerebral hemorrhage is a general definition of all intracranial hemorrhages. It is dangerous due to damage to the child’s tissues and organs and further disruption of their functionality.

information Cerebral hemorrhage is more common if the baby is not full term and was born weighing less than 1500 g. For example, the probability of intracranial hemorrhage in a child born at term reaches 0.0001, versus 50% in a premature one.

Classification of hemorrhages

According to the World Health Organization (WHO), hemorrhages are divided into four types: intracerebral, subarachnoid, subdural, intraventricular. However, it is also customary to classify them by location:

Epidural. They are a consequence of fractures and. In infants, this may result from malformations of the skull. Blood enters between the skull and the meninges.
Intracerebral. Bleeding into brain tissue. In this case, the area of the brain damaged by the outpouring ceases to function, which is accompanied by corresponding symptoms.
Intraventricular. Blood enters the cavities of the ventricles. The consequences of such hemorrhage are: inability to suck, swallow, hydrocephalic syndrome, inhibition of tendon reflexes.
Subarachnoid. They occur when vessels or connecting veins are damaged in the subarachnoid space, veins in the choroid plexuses of the pia mater. Blood enters between the inner and middle membranes of the brain.
Subdural. Blood flows between the meninges, namely under the dura mater of the brain. They appear as a result of difficult or first births, or the heavy weight of the baby. The following symptoms are characteristic of subdural hemorrhage: hypertension, hemorrhage in the retina and quickly.

Causes

The most common cause of cerebral hemorrhage in newborns is prematurity. Babies born before 32 weeks are at greatest risk; for them, from the third to the seventh day of birth, an ultrasound examination of the head is performed to find symptoms of the disease. With each subsequent week of pregnancy, the risk of hemorrhage decreases. The risk of hemorrhage is high in the first seven days after birth, after which the child is in almost no danger.

Often, cerebral hemorrhages occur due to toxicosis in the second half of pregnancy, errors by medical staff during childbirth, and infections. It happens that one child has two different types of cerebral hemorrhage.

Symptoms of cerebral hemorrhage in a child

For all types of cerebral hemorrhage, the first symptoms are approximately the same:

convulsions;
detachment of consciousness (the child is lethargic, inactive);
vomit;

important All of these symptoms occur suddenly, most often while the child is awake. Each of their manifestations helps doctors judge the location of the hemorrhage, so it is worth carefully monitoring and remembering the child’s condition.

Symptoms of hemorrhage in the deep sections:

breathing problems;
lack of pupillary reaction to light;
vomit;
deep coma;
persistent deviation of gaze (often towards the damaged part of the head);
hypothermia;
sudden hemiplegia (impaired limb function on one side);
bradycardia.

Symptoms of bleeding into the gray and white matter:

impaired coordination and orientation in space;
mental disorders (excessive agitation, slowness);
convulsions;
hemiplegia accompanied by muscle weakness;
foot syndromes in pathology (reflex extension of the big toe, reflex flexion of the II-V fingers with a light blow to them).

Symptoms of hemorrhage in the cerebellum:

pain in the occipital region of the head;
dizziness, persistent or recurring vomiting;
miosis (constriction of the pupils);
disturbance of consciousness;
steady tilt of the head back or to the side;
persistent deviation of gaze (often away from the damaged part of the head);
ataxia (impaired coordination of movements).

important The consequences of a cerebral hemorrhage can have different manifestations, so it cannot be diagnosed only by a symptom map; the doctor is always required to do an X-ray of the head, echoencephaloscopy, MRI (magnetic resonance imaging) or a spinal puncture.

Treatment

Cerebral hemorrhage in newborns has certain standards of treatment, but it is complicated by many factors. Such diseases require special management, different from the management of hemorrhages in older children, and, especially, adults.

The most effective method is surgical treatment which involves removing the resulting hematoma. Subsequent drug therapy is aimed at treating the symptoms of the disease and reducing the risk of recurrent vascular ruptures. With proper treatment started in a timely manner, there is a chance that a cerebral hemorrhage will go away without consequences over time.

Prevention of cerebral hemorrhages in a newborn

It is impossible to name a single remedy for cerebral hemorrhage in newborns. But there are two main methods of prevention:

Taking antenatal corticosteroids before premature birth, it improves lung development, which helps blood vessels withstand the stress of the first period of life.
Taking indomethacin for newborns, which also helps blood vessels at first. Thanks to this drug, they narrow and more easily withstand pressure changes.

Cardiologist

Higher education:

Cardiologist

Kabardino-Balkarian State University named after. HM. Berbekova, Faculty of Medicine (KBSU)

Level of education – Specialist

Additional education:

"Cardiology"

State educational institution "Institute for Advanced Medical Studies" of the Ministry of Health and Social Development of Chuvashia

It is believed that stroke is an “age-related” disease and mainly affects older heart patients. But the high percentage of deaths and disabilities after childhood stroke brings the problem to the forefront of medical practice. It is not easy to identify pathology in children, and they need help literally in the first hours of the development of disorders of the blood supply to the brain. It is extremely important for parents to know the warning signs of a stroke in order to prevent negative consequences.

Brain catastrophe in children

Brain catastrophe can occur at any age, even during fetal development. A number of signs distinguish childhood stroke from disorders of the blood supply to the brain in adults. In children:

the condition is more often diagnosed when blood vessels in the brain rupture;
local neurological symptoms predominate (in adults – cerebral);
the pathology is characterized by difficulty in diagnosing (patients have no obvious symptoms for up to a year);
microstrokes and lacunar cerebral necrosis often occur with minimal signs of damage;
recovery of neurological changes occurs faster.

In terms of general symptoms, the pathology in adults and infants manifests itself almost identically.

Types of pathology

As in adult patients, stroke in children is characterized by a sudden disruption of blood circulation. According to the causes of development, several forms of stroke are distinguished:

hemorrhagic - accumulation of blood spilled from blood vessels in the brain;
ischemic – thrombotic blockage of the lumen of a cerebral vessel;
combined – occlusion of cerebral vessels, complicated by hemorrhages. Rarely observed, extremely dangerous.

Disruption of blood flow in the vessels of the brain has two periods of development:

perinatal (from 28 weeks of intrauterine development to 1 month of a newborn’s life);
juvenile (in a child from one month to 18 years).

Perinatal stroke is diagnosed more often.

Age specifics

The causes of the development of pathology and its symptoms depend on the age of the child.

Age-related features of stroke development

Criterion	Perinatal stroke	Juvenile stroke
Reasons for development	Hemorrhagic stroke in children is provoked by sudden birth, low weight of the baby, or rupture of an aneurysm. The ischemic type of pathology is caused by congenital heart defects, dehydration, infectious brain lesions, protein deficiency	Hemorrhage can occur due to rupture of an aneurysm, inflammation of the walls of blood vessels (vasculitis), blood diseases, drug addiction, and cranial injuries. Thrombosis is promoted by congenital pathologies of cerebral vessels, heart defects, cancer, neck injuries
Symptoms	In the first three days after birth, the baby exhibits restlessness, causeless anxiety, constant monotonous crying, sleep problems, lethargy, and indifference. Any touch or sound provokes a violent reaction. Swallowing and sucking reflexes suffer, and frequent regurgitation is observed. Limb spasms occur, the muscles of the back of the head are constantly tense. Progressive strabismus appears	Typically, signs of a hemorrhagic stroke are observed: a skewed smile, problems with limb mobility, slurred speech, and intense headache. Against the background of general weakness, limbs go numb and convulsions occur. Dizziness causes problems with coordination of movements (sometimes to the point of fainting). Severe vomiting occurs, vision often deteriorates in one eye, and swallowing reflexes weaken. Sometimes there is unilateral paralysis

Hemorrhagic juvenile stroke can be fatal.

Stroke: features of types

Ischemic and hemorrhagic strokes differ in their manifestations and causes. The treatment of these types of pathologies also has its own subtleties.

Features of ischemic and hemorrhagic types of stroke

Criterion	Stroke
	Hemorrhagic	Ischemic
Reasons for development	Pathologies of intrauterine development - structural changes in cerebral vessels, aneurysms, infectious lesions of blood vessels. Viral and bacterial inflammation of brain structures, neoplasms, skull injuries. Endocrine diseases, high blood pressure	Heart defects (congenital, acquired), blood pathologies (increased viscosity, rapid clotting). Chicken pox, encephalitis, meningitis, vasculitis, metabolic pathologies, allergic reactions. Prolonged spasms of cerebral vessels, surgery on the brain, heart, high blood pressure
Diagnostics	MRI, conventional or spiral CT, angiography, lumbar puncture. Repeated CT examinations are recommended to track the evolution of pathology. Differential diagnosis from ischemic stroke should be carried out. Intracerebral hematomas are differentiated from hematomas of other etiologies, hemorrhages in the area of ischemia and neoplasms	Blood tests (general and biochemical), coagulography, clinical urine analysis, MRI, CT. Differential diagnosis is necessary for hemorrhagic stroke, acute metabolic, hypertensive, toxic encephalopathy, brain tumors, infectious pathologies of the brain (abscess, encephalitis)
Specific treatment	The basis of therapy is normalization of blood pressure (sodium nitroprusside, Enalapril, Amlodipine, Losartan). Signs of cerebral edema are combated by administering glucocorticoids (Dexamethasone). For hemorrhages under the meninges, aminocaproic acid is prescribed. The blood is stopped with Etamsylate, and Rutin and Ascorbic acid are used to improve the permeability of vascular walls. Nimotop relieves vascular spasms. Surgical treatment – aneurysm clipping, catheterization of the damaged vessel	To improve cerebral blood supply to the brain, Reopoliglucin, Actilyse, Trental on sodium chloride are administered intravenously. Aspirin medications are prescribed. Heparin (Logiparin, Dalteparin, Fraxiparin) is injected subcutaneously into the abdomen. Vasoactive drugs (Eufillin, Cinnarizine, Vinpocetine), nootropics (Cerebrolysin, Mexidol, Piracetam, Glycine) are indicated. Gliatilin is often used. Surgical therapy – removal of the affected vessel, restoration of blood supply by shunting

In newborns, with proper care, the consequences of cerebral hemorrhages do not lead to significant problems. But recovery is influenced by various factors, including proper rehabilitation.

General principles of treatment

To provide first aid, a number of actions are carried out:

Lay the child down, raising his head;
Open the windows to ensure sufficient air access;
Unfasten or remove tight clothing;
If vomiting or convulsions occur, turn your head to one side and, if necessary, clean your mouth;
Call a medical team;
If breathing stops, perform resuscitation.

All activities should be carried out quickly and clearly; the child’s further recovery depends on this. Basic therapy is carried out in a hospital and eliminates the danger to the child’s life:

normalizes blood pressure and heart rhythm;
localizes cerebral edema;
restores metabolic processes;
relieves cramps and pain.

The main therapy depends on the type of stroke.

Rehabilitation measures

Restorative measures follow after the acute phase of a stroke. They are carried out in two stages:

The first is based on doctor’s prescriptions, proper nutrition, and rest. Therapeutic massages, physiotherapy, exercise therapy are indicated. Then the rehabilitation process includes sessions with a rehabilitation therapist, speech therapist, and psychologist;
the second is developed individually. Its duration depends on the severity of neurological disorders.

The best option for the second stage is for the child to be in a rehabilitation center. Using the necessary medical equipment, medical staff will help restore:

motor skills (teaching aids);
muscle tone, motor coordination (massage, exercise therapy, electrical stimulation, paraffin applications);
speech (exercises with a neuropsychologist, speech therapist, course massage of the hands);
mental activity (taking neurotrophic drugs, nootropics).

Children recover faster after a stroke than adults. The functions of dead neurons are taken over by other brain cells. This is a slow and difficult process, but it is much easier for babies to regain lost functions.

From the moment of birth, the child is under the close supervision of doctors. Alarming signs in the first hours of life include frequent changes in the child’s activity, a drop in temperature and cooling of the limbs. In this case, intracranial hemorrhage may be suspected.

Such bleeding can begin due to birth trauma or household negligence. Depending on the location, intracranial bleeding is divided into deep and superficial.

In each case, bleeding has an individual character, but they can be combined based on the similarity of symptoms. One obvious symptom is the alternation of lethargy and excitability of the baby for no apparent reason. Seizures or movement disorders may occur. It is worth paying attention to the appearance of the fontanel - if it is strongly bulging and the symptoms described above are present, you should immediately go to the hospital.

In addition, symptoms may include increased regurgitation, weight loss, intestinal upset, shortness of breath, and an excessively rapid baby's heartbeat. If these signs develop in a short time, an urgent examination is necessary.

Risk factors

Most often, hemorrhages occur in premature infants whose weight was less than one and a half kilograms.

Full-term babies with normal weight may be at risk if the birth was rapid, or the mother suffered an infectious disease during pregnancy.

It is widely believed that such bleeding can be caused by mechanical damage to the baby during childbirth. These data have not been confirmed by official medicine.

Intracranial bleeding can occur with intravenous injections or excess oxygen during oxygen therapy.

Causes of hemorrhage in newborns

Bleeding in the brain occurs due to damage to the vessels inside the skull. Blood enters the lining of the brain. Vascular rupture is caused by injury or hypoxia.

Medical studies have shown that bleeding in newborns can be caused by:

Violation of pregnancy terms (not full-term or post-term baby);
Large head circumference of the baby and unpreparedness of the mother’s birth canal;
Mycoplasma, hypoxia, intrauterine infectious diseases;
Long or short labor;
Medical errors during childbirth.

To accurately identify pathology, a tomography of the baby’s head is performed.

Classification of hemorrhages in newborns

Subarachnoid hemorrhage in a newborn

One of the most common types of hemorrhages in children is subarachnoid. Its cause is the rupture of blood vessels inside the arachnoid and soft membranes of the brain. Most often, the cause may be prolonged labor. If the problem is not recognized in time, an inflammatory process begins due to the breakdown of blood at the site of bleeding.

Main symptoms:

Overexcitement, poor sleep;
Constant crying;
Strabismus;
Increased head volume;
Convulsions;
Neck muscle tension.

With immediate detection of the disease and proper treatment, hemorrhage leaves no consequences.

Subdural hemorrhages in newborns

Subdural hemorrhage in newborns is caused by rupture of venous vessels.

This type of damage is caused by acute trauma. It leads to an outpouring of blood into the area between the dura mater and the brain. A hematoma forms, which rapidly increases and compresses the brain. The consequences of such a pathology are very dangerous and can lead to death.

In addition to injuries, aneurysms and brain tumors can lead to subdural bleeding.

The most common causes of this hemorrhage are the following:

The fruit is too large;
Rigidity of the uterus (in women giving birth for the first time and during late labor);
The rapidity or protracted nature of labor;
Vacuum extraction or turning of the baby during labor;
Prematurity (too soft skull bones).

Symptoms of subdural bleeding in newborns:

Muscle tension in the back of the head;
Throwing back the head;
Non-response of the pupil to light;
Bradycardia;
Cramps.

The condition of a child with this pathology is serious; death can occur within two days.

With immediate diagnosis and removal of the hematoma, in half of the cases it is possible to save the newborn a full life. The rest experience serious damage to the neurological system, hydrocephalus and death.

Intraventricular hemorrhage in a newborn

Asphyxia and hypoxia lead to the development of intraventricular hemorrhage in infants. At risk are premature babies whose circulatory system and structural parts of the brain are not fully formed. In babies born prematurely, the head contains the germinal matrix, a structure that later turns into the framework of the brain. With IVH, the process of transformation of the matrix is disrupted, which leads to a delay in the development of the child

This pathology has four degrees of severity. In the first two, there are no symptoms or consequences of the disease, and its presence is diagnosed only by tomography and sonography. In the third and fourth degrees, hydrocephalus begins, the spread of bleeding to brain tissue, and, as a result, neurological changes.

Subependymal hemorrhage in newborns

Subependymal hemorrhage occurs due to cerebral hypoxia. Symptoms in newborn babies include:

Hand hypotension;
Mild changes in excitement and lethargy;
Excessive eye mobility;
Unsharp tilting of the head.

An indicative sign of this condition is repeated attacks of apnea. To identify the disease, the baby undergoes neurosonography. It is not always possible to recognize SEC in the first hours of life. Often, symptoms appear in the second week or even several months after birth. A prolonged course of the disease leads to the formation of a cyst in the brain.

Parenchymal hemorrhage in a newborn

A complication of IVH can be blood entering the brain. This process is called parenchymatosis.

The pathology begins due to brain damage from a viral infection or blood clotting disorders in the child (difference in the Rh factors of the baby and the mother). Causes may include asphyxia or birth trauma.

With such bleeding there is a high risk to the baby's life. If the outcome is positive, after the hematoma resolves, a cyst forms, which occupies the affected area of the brain. This process leads to serious neurological impairment and developmental delays.

Other types of hemorrhages in newborns

Cerebral hemorrhage in a newborn, as described above, is divided into:

Epidural;
Subarachnoid;
Hemorrhages in the substance of the brain and ventricles;
Subdural.

In the first days of life, other types of bleeding may be detected in infants.

Hemorrhage in the adrenal gland in a newborn

It can develop due to incorrect obstetric management of labor and mechanical trauma to the fetus.

On the third day of the child’s life, the resulting hematoma disintegrates and a sharp deterioration in the baby’s condition is observed. The signs are:

Severe muscle hypotension;
Pressure drop;
Vomit;
Intestinal paresis.

For diagnostic purposes, urgent radiography and ultrasound of the abdominal cavity are prescribed.

Treatment may require surgery to remove the hematoma and hormonal therapy. The consequences of the disease can be chronic adrenal insufficiency.

Bleeding in the eye in newborns

It is observed in forty percent of cases during difficult labor with the use of stimulating medications and vacuum obstetrics. Typically, such bleeding disappears without a trace in the first couple of weeks and is in no way related to cerebral hemorrhages.

Treatment of hemorrhages in newborns

Treatment of hemorrhages in infants is mainly supportive in nature, with the exception of cases when surgical intervention is required to eliminate hematomas. All children receive vitamin K, which helps resolve blood clots. For certain indications, they are prescribed clotting factors

A sick baby is protected from noise and bright light. To completely eliminate any stress, they are fed through a feeding tube.

Basic principles of caring for a newborn with hemorrhage:

You should not make sudden movements when changing clothes and bathing your baby;
Care should be taken to ensure that the child does not fall or lean head down;
It is necessary to constantly monitor body temperature to detect exacerbations of the condition.

Consequences of hemorrhage in newborns

The consequences of bleeding in infants directly depend on the area and severity of the lesion. It is more difficult for a child to cope with complications, since he is not able to actively participate in rehabilitation activities.

Possible consequences of bleeding in infancy may include:

Complete or partial paralysis;
Developmental disorders;
Coma;
Suppression of the reflexive apparatus;
Brain swelling
Strabismus;
Speech disorders.

With correct and immediate diagnosis, in most cases it is possible to avoid serious complications. Treatment and rehabilitation efforts of parents will help the baby recover and develop normally.

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:

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.
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.
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:

Depression of consciousness;
Paresis or muscle weakness;
Oculomotor disorders (histagmus, strabismus);
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. The occurrence of IVH in newborns may be indicated by a drop in hematocrit level, a decrease in calcium, fluctuations in blood sugar, and often disorders of the blood gas composition (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:

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);
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:

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 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.

The birth of a child is always associated with certain difficulties, which can be very unpredictable and sometimes even dangerous. As a result of childbirth, the baby can suffer serious injuries and damage, including disruption of the nervous system. The reasons for the occurrence of such consequences can be very different, and treatment may not always give a positive result. However, the sooner any disorder is identified, the sooner therapy begins, the higher the chance of restoring normal functions of your baby’s body.

Errors by obstetricians, difficult childbirth and pregnancy, trauma to the newborn - all this can lead to cerebral hemorrhage.

Causes of cerebral hemorrhage in a newborn

Any bleeding is a consequence of ruptured blood vessels. Usually it occurs due to damage to the still fragile bones of the skull or hypoxia during childbirth - due to oxygen starvation of the newborn.

The main reasons are:

Complications during pregnancy, illness of the mother that is transmitted to the fetus.
Complications during childbirth that arise due to their rapidity or, conversely, duration.
The birth of a child before or significantly after term.
Discrepancy between the size of the baby's head and the birth canal.
Incorrect intervention by obstetricians.

All this can cause serious problems in brain function and is one of the main causes of child mortality. Unfortunately, no one is immune from such factors, but timely measures to provide assistance can save the life and health of a child.

Types and symptoms of intracranial hemorrhage

Types are divided based on localization:

Epidural.

They occur when the integrity of the vessels located between the skull and the brain is damaged; their cause is most often damage to the bones of the cranial vault.

Symptoms of epidural bleeding:

Pupil dilation on the side of hemorrhage.
Low blood pressure and slow heart rate.
Hypoxia, suffocation.
Cramps.

Epidural bleeding is dangerous because a few minutes after its occurrence, a period of calm begins, which can last up to 6 hours. However, after this time, compression of the brain occurs, and the newborn becomes significantly worse. After two days, the baby may fall into a coma, and treatment will no longer help. Therefore, if any of these symptoms occur, immediate medical intervention is required.

Subdural.

Hemorrhage occurs between the two membranes of the brain: hard and soft. It can occur due to labor that is too fast or too long, as well as due to the large weight of the newborn. The main cause is displacement or damage to the bones of the skull. At this stage of medical development, it is extremely rare, since the development of medicine and the improvement of childbirth techniques make it possible to avoid subdural bleeding. However, the risk of such bleeding occurring during home birth or childbirth outside a medical facility, without competent obstetric care, is high.

The future life of the child depends entirely on how quickly and how correctly the diagnosis was made. If you seek medical help late, it can lead to the development of nervous system disorders and other pathologies.

Symptoms of subdural bleeding:

Deviation of the eyeballs, resulting in clearly visible squint.
Lack of pupillary response to light.
Stiff neck.
Coma.

When subdural bleeding occurs, the child’s condition is severe from the first minutes of birth; death as a result of unprovided or insufficient prompt medical care occurs within two days after birth.

Subarachnoid.

The most common hemorrhages that can occur in newborns. Most often occurs in infants born before the third trimester of pregnancy, as a result of rupture of blood vessels between the arachnoid membrane and the gray medulla. The main cause of subarachnoid bleeding is prolonged labor and/or improper intervention by midwives. The result of the pathology is inflammation of the meninges, which can lead to serious disorders in the central nervous system and mental disorders in the future.

Symptoms of subarachnoid bleeding:

General excited state of the newborn, constant crying.
Sleep disturbance, the child constantly keeps his eyes open.
Negative reaction to any irritation.
Divergence of the skull bones.
Cramps.

Signs appear immediately after birth or after a few days, especially in premature babies. With this type of bleeding, the degree of consequences may be insignificant if treatment is started in a timely manner.

Hemorrhage into the gray matter and ventricles of the brain.

The main location is the cavity of the brain, but hemorrhages can penetrate directly into the gray matter of the brain. The main risk group is premature babies born before the beginning of the third trimester of pregnancy, whose brain has not yet fully developed.

Such bleeding occurs in the first day of a newborn’s life, and often does not cause complications in the future. However, if the hemorrhage is severe, the cavities fill with blood, which almost displaces the natural fluid. This can cause developmental delay, cerebral palsy and other consequences, even if treatment was started in a timely manner and carried out correctly.

Symptoms of hemorrhage:

Deterioration of the child's condition.
Severe swelling of the fontanel.
Violation of thermoregulation.
Digestive disorders.
Anemia.
The occurrence of concomitant somatic diseases.

Atypical intracranial hemorrhages may be caused by abnormal vascular development, tumors, or hemorrhagic infarction. These pathologies, in turn, may be a consequence of the mother taking acetylsalicylic acid and sulfonamide drugs during pregnancy. Also, the cause of intracranial hemorrhage in a newborn can be the mother’s poor lifestyle during pregnancy: drinking alcohol, smoking, non-compliance with the daily routine and diet.