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

Hemorrhage in the brain in newborns is the result of a rupture of an intracranial vessel. This is a severe injury that affects the development of the child, after which many complications are possible. Hemorrhage occurs for the following reasons - early childbirth, severe pregnancy, incorrect obstetric measures. The consequences depend on the place and degree of distribution, but are unfavorable.

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

In order, starting from the cranial vault, the dura mater covers the top of the brain. In Latin, it is called "dura mater", because the bleeding between the skull and the hard shell is called epidural, and under the hard shell - subdural bleeding.
The next shell is arachnoid. Beneath it is a mass of cerebrospinal fluid. Another name is arachnoid.
It is followed by "pia mater" - the soft shell is adjacent to the brain throughout, performing a protective function.
Also, the brain is lined with ependyma - an epithelial layer that envelops the brain and performs a protective function.

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

Types and degrees of hemorrhage in children

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

epidural;
subdural;
Subarachnoid
Ventricular

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

1 degree - subependymal hemorrhage;
Grade 2 - blood partially or completely filled the lateral ventricle of the brain, without increasing its size;
Grade 3 - blood filled the ventricle and increased it in size;
Grade 4 - blood expanded the ventricle and penetrated into the substance of the brain.

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

Hemorrhages according to ICD-10:

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

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

Symptoms

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

epidural

Symptoms of an epidural hemorrhage:

On the damaged side, a visible dilation of the pupil;
- reduced heartbeat;
Reduced blood pressure;
Hypoxia, or suffocation;
Muscle cramps.

Epidural bleeding is the result of damage to the cranial vault. Premature babies especially often have a too plastic skull, which is easily displaced. Vessels are broken between the dural and bone layers, leading to the ejection of blood under the skull.

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

Symptoms of subdural hemorrhage: In general, the symptoms are the same as epidural, with the difference that there is no compression syndrome. Such a hemorrhage almost never occurs in medical practice at the moment due to the improvement of the obstetrics technique.

subarachnoid

Signs of subarachnoid hemorrhage:

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

This is a consequence of rupture of blood vessels under the arachnoid membrane of the brain. The decay products of the blood settle on the cortical substance and cause the development of inflammation. Subarachnoid hemorrhage is a consequence of obstetric intervention, and it is the most dangerous.

Parenchymal and intraventricular

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

With complete filling of the ventricles and spreading into the substance of the brain, if the treatment was started too late, the consequence will be the development of mental abnormalities, the signs of which appear much later.

Causes

The causes of cerebral hemorrhage are quite extensive. In each individual case, you can identify your reasons, however, in most cases, the following list is observed:

Fetal hypoxia due to smoking;
prematurity;
Mistakes of doctors during childbirth;
intrauterine infections.

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

Too long childbirth can also lead to occlusion of only working vessels, which, at the first breath - the first sips of external oxygen, will most likely burst and fill the spaces around.

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

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

Features and risk factors

Many factors can provoke intracranial bleeding. This is due both to pathological pregnancy and to the banal negligence of doctors. In this case, the 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, such a 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 are considered pathological and cause brain hypoxia in the fetus.
Use of obstetrical forceps that damage the baby's skull.
Postponed pregnancy. In this condition, the baby's skull bones lose their elasticity, increasing the risk of injury during childbirth.
The defeat of intrauterine infection.
Too large fetus in a woman with a narrow pelvis.
Various vices in children.

Remember! Premature babies have a 50% risk of trauma during childbirth with further intracranial hemorrhage. The highest probability of pathology in this case is in babies 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 response to even a small stimulus,
convulsions,
critical weight loss
frequent vomiting
increased intracranial pressure,
poor appetite.

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

This pathology has the following varieties:

Subarachnoid lesion. It is typical for premature babies, as well as with the use of auxiliary manipulations during childbirth. In this state, there is damage to the vessels over the substance of the brain, which leads to strabismus, constant screaming, convulsions, disturbed sleep.
epidural view. This pathology leads to damage to the vessels that are under the bones of the skull. A complication develops with a post-term pregnancy or rapid delivery. Symptoms of such a hemorrhage will be low blood pressure, convulsions, hypoxia, and a dilated pupil on the affected side of the head.
Subdural view. Pathology is accompanied by the accumulation of blood between the meninges. Most often it is 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 period of the first week after the birth of a child is considered the most dangerous, when the initial symptoms of hemorrhage are detected. If deterioration is not 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 by 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 focus of the 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 neglect (grade 1, 2 or 3) and the type of pathology. In this case, a specific course of treatment is selected by the attending physician on an individual basis for each individual baby. In this case, the doctor must take into account the neglect of the condition, the symptoms and the severity of brain damage.

The acute period of the disease needs to restore the functions of the brain, heart and respiration. The general course of therapy is aimed at normalizing blood circulation.

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

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

A puncture is performed to reduce intracranial pressure.

With severe bleeding, drugs Vikasol or calcium Chloride are prescribed.
To restore important trace elements in the body, the course of treatment includes Glucose, Sodium sulfate, Panangin.

To help your child, parents should follow these tips:

do not self-medicate and immediately agree to the hospitalization of the baby,
keep breastfeeding as long as possible,
fulfill all medical orders,
carry out the necessary hygiene measures for the newborn,
do not leave crying unattended.

Possible complications

The brain of infants has excellent ability to recover, therefore, with a slight pathology, the prognosis for the baby 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 can develop the following complications:

epilepsy,
developmental disorder,
neurological disorders,
death.

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

Rehabilitation

In the first days after the detection of pathology, the child should be under constant medical supervision. Usually these babies are transferred to intensive care.

To improve the condition of the baby, 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 of the newborn, you need to breastfeed. In case of violation of the swallowing function, a probe is inserted.

With the normalization of the child's condition and after the end of drug therapy, a rehabilitation course should be carried out. It includes massage and special gymnastics. As the child grows older, they may need swimming lessons and speech therapy lessons.

Also, without fail, such patients should be regularly observed by a doctor (pediatrician, neuropathologist, 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 after.

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

The entire pregnancy is periodically monitored by a doctor.
Take care of your health and avoid stress.
Refuse hard physical work, which can cause premature birth.
Timely treat infectious diseases that can harm the fetus and provoke complications.
Give up bad habits (smoking, drinking alcohol) and adhere to proper nutrition.
Carefully approach the choice of clinics and the doctor who will take delivery.

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 against unwanted consequences.

Cerebral hemorrhage in newborns is a serious pathology that develops as a result of damage to the vessels of the dura mater or rupture of the vessel of the brain. This often happens with birth trauma. According to statistics, intracranial hemorrhage of the ICH) occurs in 1 out of 1000 cases in full-term babies. 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 such complications 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, the place of its localization, the general condition of the baby and the compensatory abilities of the brain.

Causes

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

One of the first reasons can be considered chronic fetal hypoxia at 26-34 weeks of gestation. The fact is that during this period, the periventricular space is literally permeated with a large number of vessels that play an important role at this stage, but eventually cease to carry functionality. In the event of complications and 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 as follows:

lack of vitamin K and K-dependent factors, other anomalies associated with the coagulation process (blood clotting);
pathologies against the background of severe hypoxia: acidosis, too strong activation of fat peroxidation, low blood pressure;
intrauterine infections with viruses, mycoplasmas that contribute to the destruction of the walls of blood vessels;
chronic diseases of the mother (for example, diabetes mellitus);
the influence of women's addictions (smoking, alcoholism);
trauma during childbirth due to narrow birth canals and a large fetal head, with rapid labor, caesarean section;
the use of obstetric aids (vacuum extraction of the fetus, obstetric forceps).

Types and degree of damage

The brain, like our other organs, has an impressive network of blood 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 in Latin "dura mater". If the hemorrhage occurs under this shell, it is called subdural, if between the shell and the skull, then epidural.

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

They say about subarachnoid hemorrhage when a rupture of the vessel occurred in the space between the arachnoid and pia mater. If the blood filled one or more ventricles, we are talking about intraventricular hemorrhage (hereinafter abbreviated IVH). Another epithelial layer that protects the brain is called the 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:

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

According to the ICD-10 classification, the division of hemorrhages occurs as follows:

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

Various diagnostic formulations sometimes confuse in making the correct diagnosis, therefore, when deciding on a treatment regimen, the doctor focuses on the results of an ultrasound examination, MRI or X-ray.

Signs of cerebral hemorrhage do not always appear immediately. Pathology can proceed the first day asymptomatically.

Symptoms

The clinical picture, depending on the localization of vascular lesions, will be somewhat different, but in general, the characteristic signs of hemorrhage in infants are identified:

a sharp deterioration in the condition, the symptoms of hyperexcitability are replaced by signs of depression;
the fontanel swells strongly, is in tension;
the strength and nature of the baby's cry changes;
convulsive activity;
peripheral circulatory disorders, palpitations, frequent regurgitation, weight loss, increased gas formation, shortness of breath, apnea;
anemic syndrome, decrease in hemoglobin in the blood;
an increase in the blood of ketone bodies, bilirubin, which poisons the body with toxins;
development of renal, cardiovascular insufficiency;
accession of a secondary infection, as a result of which the development of sepsis, meningitis, pneumonia is possible.

Now we characterize the clinical picture in individual situations:

SEC

One of the most common forms of hemorrhage. There are no specific symptoms of SEC. Its most important manifestation is considered to be repeated bouts of apnea in the first days of a newborn's life. 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 in symptoms of mild depression/excitation. As a result of SEC, a cyst often forms.

Intraventricular hemorrhage in newborns

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

All this happens due to an increase in fluid volume, a sharp increase in intracranial pressure and, as a result, cerebral edema and compression of the nerve centers responsible for various work in our body.

If blood erupts 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. Symptoms have 2 phases: convulsions and a decrease in all reflexes and functions of organs up to loss of consciousness, then "enlightenment" occurs.

With subdural hemorrhage, the picture is almost the same, so that the 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 there may not be any visible violations. Then the processes of excitation/oppression alternate. Even with the development of seizures in the intervals between them, the child looks completely healthy. The prognosis and the need for treatment will again depend on the extent of the lesion.

Diagnosis and treatment

The diagnosis is established on the basis of the results of ultrasound examination through the fontanel and computed tomography, as well as judging by 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 swelling of the brain. At the same time, it is necessary to maintain cerebral blood flow.

With the help of CT, you can see the extent of the hemorrhage and its localization.

If this treatment fails, surgery is indicated: shunting.

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

Prevention

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

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

This dangerous process causes malfunctions of the whole organism. If timely medical care is not provided, the pathology can lead to the death of the child.

Brain hemorrhage requires mandatory medical treatment

Causes of cerebral hemorrhage in newborns

The main causes of blood entering the brain of babies:

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

Hemorrhage can be detected immediately after the birth of the child. Often, intracranial hematoma occurs in the first month of a baby's life.

Types and degrees of hemorrhages

Depending on the localization, several types of hemorrhages are distinguished:

epidural;
subarachnoid;
subdural;
intraventricular.

Epidural is the most severe type of pathology. Appears in newborns due to injury to the vessel, when blood flows into the space between the skull and the membrane of the brain. It develops due to bruises and during childbirth. In this case, the child is observed:

dilation of the pupils of the eyes;
convulsions;
decrease in cardiac and respiratory activity;
hypoxia.

With epidural hemorrhage, the cardiac and respiratory activity of the newborn is reduced

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

Subarochnoid (subependymal) - a hemorrhage that is localized between the membrane of the brain and the gray matter (see also:). The most common type. The rupture of the vessel occurs during childbirth, premature babies are more susceptible to its appearance. Typical symptoms:

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

These symptoms appear immediately and require medical procedures. With competent actions of doctors, the consequences for the child will be minimal.

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

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

The resulting hematoma is growing rapidly. If you do not provide the necessary assistance, there will be a fatal outcome.

Intraventricular - the entry of blood into the gray matter of the brain and the ventricular space. It affects children born much earlier than the due date. As a result of pathology, the baby may have a sucking, swallowing and tendon reflex. Intraventricular hemorrhage is characterized by:

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

Cephalhematoma in a newborn against the background of hemorrhage (more in the article:)

The degree of development of hemorrhage:

1 degree. Blood does not flow into the cavity of the ventricles and the brain, as it is delayed by the wall of the ventricles.
2 degree. Blood enters the cavity of the ventricles.
3 degree. Hemorrhage is noticeable on MRI as blood enters the lateral ventricles and the space between them.
4 degree. Hemorrhage in the gray matter of the brain.

Symptoms

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

loss of consciousness;
lethargy, apathy;
severe vomiting, frequent regurgitation;
convulsions;
pain in the head.

With hemorrhage in the deep layers of the brain, there may be no reaction of the eyes to light

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

loss of consciousness;
coma;
lack of eye response to light;
quickening or slowing of breathing;
decrease in temperature;
limb dysfunction.

Signs of blood getting into the white or gray matter of the brain:

convulsions;
weakening of muscle tone;
excitability or lethargy;
violation or complete lack of sleep;
strong, incessant crying.

When blood enters the cerebellum, there is:

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

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

Consequences for children

The danger of pathology lies in the fact that when a vessel ruptures, some parts of the brain cease to receive micronutrients and oxygen and are squeezed by the accumulated fluid. The consequences depend on the speed of medical care and the degree of damage. Minor hemorrhage with timely detection and treatment will not cause serious harm to the child. The course of treatment can range from 2 months to several years.

Consequences of a more severe form of pathology:

coma;
hydrocephalus (we recommend reading:);
epilepsy;
developmental disorder;
swelling of the brain;
strabismus;
speech disorders.

Treatment of pathology

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

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

Medical therapy includes:

taking drugs that increase the amount of urine - to reduce the risk of developing cerebral and pulmonary edema;
puncture - piercing the meninges to reduce intracranial pressure, as a result of which the accumulated fluid is removed;
taking hormonal drugs - in violation of the adrenal glands;
appointment of therapeutic massage and coursework with a speech therapist.

Newborns need to be cared for with care. Basic principles:

do not allow sudden movements when changing clothes and bathing the child;
exclude falling;
constantly monitor the baby's body temperature.

Some stages of hemorrhage require surgical intervention. An operation can be prescribed for severe brain damage and a serious condition of the patient.

Types of surgical operations:

craniotomy;
minimally invasive operation;
stereotactic removal of a blood clot.

Prevention of cerebral hemorrhage in children

Hemorrhage in the brain is a terrible pathology. Preventive measures should be taken to protect children from it:

during the period of pregnancy planning, be screened for toxoplasmosis and genitourinary infections (see also:);
stop smoking and drinking alcoholic beverages;
responsibly approach the choice of a maternity hospital and a doctor who will take delivery, take into account the reviews of friends.

Unfortunately, no one is immune from medical errors. It is necessary to carefully monitor the condition of the baby in the first month of life.

Hemorrhage in the brain- this is the flow of blood from an injured vessel into the inside of the cranium and the gray matter of the brain, in which quite serious damage to internal tissues and organs is diagnosed, followed by a violation of the entire functionality of the body.

For the most part, this is due to trauma to the skull and brain of the child during childbirth, although the negligence of doctors, prematurity, or, conversely, postmaturity of the fetus can also provoke damage. Of course outpouring of blood can enter the brain in any of its zones.

Types of cerebral hemorrhage in an infant

In accordance with the classification given by WHO, the outpouring of blood into the brain is divided into 4 subsequent views that are defined by their own location.

epidural

In this case, there is hemorrhage, formed from a damaged vessel and located between the cranium and the outer shell of the gray matter. Such bleeding can occur with head injuries, including in the process of the mother's labor and the birth of the child, domestic injuries and injuries.

In the case of diagnosing this type of hemorrhage in a child:

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

Feature of this hemorrhages there is that the symptomatology will not manifest itself immediately, but 5-6 hours after the rupture of the vessels occurs. If you do not prescribe effective treatment in a timely manner, the patient's condition will deteriorate sharply, the baby may fall into a coma - this is the most severe of all types of hemorrhage.

Subdural

In this case, the focus of localization bleeding there is an area between the soft tissues and the dura mater of the brain - a frequent root cause is too prolonged childbirth or, conversely, a rapid resolution from childbirth.

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

Subarachnoid

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

The cause of this pathology may be thinning a vessel or an injury received - it is most often diagnosed in a premature baby, especially if the labor activity of the woman in labor was delayed and obstetric care was provided. When diagnosing this type of hemorrhage, the entire remaining blood decay product leads to inflammation of the brain membrane.

This pathology can manifest itself in the fact that:

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

If there was a subarachnoid hemorrhage, then the baby:

head will increase in size;
may squint eyes and move involuntarily;
muscles the back of the head will be visibly tense;
frequent bouts of muscle cramps.

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

Hemorrhage into the substance of the brain and ventricles

In this case blood gets straight into the tissues and the very gray matter of the brain, as well as into the space between the ventricles, the cavity of the brain. Such a hemorrhage is most often diagnosed in a severely premature baby born up to the 32nd week of the term whose brain is underdeveloped.

Causes and signs

For the most part, doctors diagnose brain hemorrhage in underdeveloped children - so according to statistics in newborns who were born with weight up to 1.5 kg similar pathology was diagnosed in 50% .

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

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

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

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

The degree of development of pathology

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

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

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

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

Symptoms

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

Why is hemorrhage dangerous?

Speaking about the danger posed by this pathology to a child, it is worth taking into account the degree of damage - the brain is distinguished by such an amazing ability self-repair.

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

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

Treatment

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

The course of treatment itself includes:

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

The child must:

prescribe several courses of therapeutic massage and gymnastics- they will improve blood flow and the state of the central nervous system.
They also prescribe a course of classes with a speech therapist for older kids.

In any case, when discharged from the hospital, such babies are registered with such highly specialized doctors as a neuropathologist and orthopedist.

Consequences

If the child has:

Diagnosed with massive hemorrhage, accompanied by a rupture of the cerebellum or sickle - this leads to a momentary deterioration in health, as well as a fatal outcome almost immediately after birth.
If there is a massive outpouring of blood into the brain, in particular, when its localization is the cerebral cortex, then huge hematomas can occur, which then resolve and after them a porencephalic cyst remains.
If there is intraventricular hemorrhage, then the consequence is the expansion of the ventricles, then in 80 percent the pathology does not cause posthemorrhagic hydrocephalus. This diagnosis develops only in 10-13% of all babies who have suffered an outpouring of blood inside the ventricles.

At first, negative symptoms may not manifest themselves, showing symptoms such as rapid head growth, CNS depression and swelling of the fontanel, divergence of the suture of the cranium only after 3-4 weeks. In 6 out of 10 cases, posthemorrhagic hydrocephalus stops growing or the development process reverses.

21.09.2016