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Intracranial hemorrhage newborn

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  • Can you provide me with any citations or other information on the prevalence and clinical insignificance of Subarachnoid hemorrhage in newborns?
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Intracranial hemorrhage newborn

  1. 1.  Incidence varies from 2% to >30% in newborns depends on the gestational age (GA) at birth and the type of ICH Diagnosis typically depends on clinical suspicion The presence and severity of parenchymal injury is the best predictor of outcome
  2. 2.  Rupture of the draining veins and sinuses of the brain molding, fronto-occipital elongation, and torsional forces acting on the head during delivery provoke laceration of dural leaflets of tentorium cerebelli or falx cerebri
  3. 3.  Often results from trauma in the full-term infant SDH in the supratentorial space results from rupture of the bridging veins
  4. 4.  large head size, rigid pelvis (e.g., in a primiparous or older multiparous mother), nonvertex presentation (breech, face, etc.), very rapid or prolonged labor or delivery, difficult instrumental delivery, or rarely, a bleeding diathesis
  5. 5.  Large collection especially in infratentorial SDH results in rapid deterioration. Systemic signs like hypovolemia and anemia Seizures may occur in up to half of neonates with SDH, particularly with SDH over the cerebral convexity
  6. 6.  suspected on the basis of history and clinical signs and confirmed with a computed tomography (CT) scan. ultrasonic imaging subdural space is inadequate MRI- timing of the lesion and for detecting other lesions Lumbar puncture after CT
  7. 7.  Most infants with do not require surgical intervention prompt stabilization with volume replacement Open surgical evacuation of the clot in case of large SDH The outcome for infants with nonsurgical SDH is usually good
  8. 8.  Primary SAH is probably frequent but clinically insignificant. normal “trauma” associated with the birth process. sourceof bleeding is usually ruptured bridging veins of the subarachnoid space or ruptured small leptomeningeal vessels
  9. 9. Usual scenar i o i s a w l el appear i ng t er m i nf antdevel opi ng SAH on day 2 or 3 of l i f e
  10. 10.  Clinical presentation is similar to other forms of ICH Thediagnosis is best established with a CT scan or MRI, or by LP to confirm or diagnose small SAH Ultrasonography is not sensitive for the detection of small SAH Management of SAH usually requires only symptomatic therapy, such as anticonvulsant therapy for seizures
  11. 11.  Rare Intracerebral or intracerebellar variety More commonly a secondary event Hypoxic ischemic brain injury, venous infarction or thrombosis, ECMO therapy, large ICH in another compartment
  12. 12.  Presentation and management similar to SDH MRI – extent and age of hemorrhage and other associated parenchymal lesions LP to rule out meningitis Symptomatic management Treatany coexisting pathology or predisposing factors Monitoring for hydrocephalus
  13. 13.  15-20% at <32 weeks gestation Venous (or sinus)thrombosis and thalamic infarction in term infants Relatedto birth trauma or perinatal asphyxia No identifiable risk factors in 25%
  14. 14. Intravascular factors • Ischemia/Reperfusion • Fluctuating or increase(Pressure passive circulation) CBF • Increase in cerebral venous pressure • Platelet dysfunction • Coagulation disturbancesVascular factors • Fragile, involuting capillaries with large diameter lumenExtravascular factors • Deficient vascular support • Excess fibrinolytic activity
  15. 15.  Usually a clinically silent syndrome in preterms Term newborns – seizures, apnea, irritability, lethargy, vomiting, full fontanelle Catastrophic presentation less likely Complications
  16. 16.  Routine CUS in all infants born at <32 weeks and in older infants at risk for IVH Days 3,7,30 and 60 days Monitoring for complications Gradingof GMH/IVH is important for determining management and prognosis
  17. 17. Grading Severity DescriptionPapile (CT) I Isolated GMH (no IVH) II IVH without ventricular dilatation III IVH with ventricular dilatation IV IVH with parenchymal hemorrhageVolpe I GMH with no or minimal IVH (<10%(CUS) ventricular volume) II IVH occupying 10-50% of ventricular area on parasagittal view III IVH occupying >50% of ventricular area, usually distending lateral ventricle Separate Periventricular echodensity notation
  18. 18.  Antenatal steroids Slow infusion of colloid or hyperosmolar solutions Avoidrapid fluctuations in CBF and hypotension Sedativeor paralytic medication in ventilated babies
  19. 19.  Supportivecare and watch for complications Maintaining Normal BP electrolytes and , blood gases Transfusions as necessary Correctthrombocytopenia and coagulation disturbances
  20. 20.  Supportive care and treatment of seizures Serial LPs and eventual VP shunts Prognosis relates to factors other than IVH alone
  21. 21. Monitor OFC and fontanelle daily, Serial CUS q2-7 days to assess ventricle size, shape and RINo PVD Slowly Progressive Rapidly progressive Ventricular dilation ventricular dilatation (over weeks) (over days)No further Close surveillance for 2-4 wktreatment Dilatation stops Continued dilatation No therapy, close Serial LP Every 1-3 d, observation for 1 yr depending on rate of ventricular dilatation

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