intracranial hemorrhage newborns

Intracranial Hemorrhage in Newborns OVERVIEW  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 SUBDURAL HEMORRHAGE (SDH)  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  Often results from trauma in the full-term infant  SDH in the supratentorial space results from rupture of the bridging veins Etiology  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 Clinical presentation  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 Diagnosis  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 Management  Most infants with 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 SUBARACHNOID HEMORRHAGE (SAH)  Primary SAH is probably frequent but clinically insignificant  normal “trauma” associated with the birth process  source of bleeding is usually ruptured bridging veins of the subarachnoid space or ruptured small leptomeningeal vessels Usual scenario is a well appearing term infant developing SAH on day or of life  Clinical presentation is similar to other forms of ICH  The diagnosis 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 INTRAPARENCHYMAL HEMORRHAGE (iph)  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  Presentation and management similar to SDH  MRI – extent and age of hemorrhage and other associated parenchymal lesions  LP to rule out meningitis  Symptomatic management  Treat any coexisting pathology or predisposing factors  Monitoring for hydrocephalus Intraventricular Hemorrhage  15-20% at [...]... such as anticonvulsant therapy for seizures INTRAPARENCHYMAL HEMORRHAGE (iph)  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  Presentation and management similar to SDH  MRI – extent and age of hemorrhage and other associated parenchymal lesions  LP to... hemorrhage and other associated parenchymal lesions  LP to rule out meningitis  Symptomatic management  Treat any coexisting pathology or predisposing factors  Monitoring for hydrocephalus Intraventricular Hemorrhage  15-20% at ...OVERVIEW  Incidence varies from 2% to >30% in newborns  depends on the gestational age (GA) at birth and the type of ICH  Diagnosis typically... suspicion  The presence and severity of parenchymal injury is the best predictor of outcome SUBDURAL HEMORRHAGE (SDH)  Rupture of the draining veins and sinuses of the brain  molding, fronto-occipital... in case of large SDH  The outcome for infants with nonsurgical SDH is usually good SUBARACHNOID HEMORRHAGE (SAH)  Primary SAH is probably frequent but clinically insignificant  normal “trauma”