文档介绍：Intracranial Hemorrhage of the Newborn ( ICH )
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Contents mastered :
The main causes of neonatal ICH
The mechanism of PVH-IVH
Classification and manifestation of PVH-IVH
Diagnosis of neonatal ICH
Prevention of neonatal ICH
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A severe disease in neonate
Related to perinatal asphyxia and trauma, and maturity of fetus
There are four major types
Subdural hemorrhage
Primary subarachnoid hemorrhage
Intracerebellar hemorrhage
Periventricular-intraventricular hemorrhage
(PVH-IVH)
Introduction
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Etiology and Epidemiology of ICH
Trauma (epidural, subdural, or subarachnoid)
fetal head is too large compared with the size of the pelvic outlet
prolonged labor/breech or precipitant deliveries
Delivery with mechanical assistance
Asphyxia/Hypoxic-ischemic encephalopathy
Maturity of neonate: germinal matrix, PVH/IVH for 20-30% infants with BW<1500g
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Primary hemorrhagic disturbance (subarachnoid or intracerebral)
DIC
isoimmune thrombocytopenia
neonatal vitamin K deficiency (maternal phenobarbital or phenytoin)
Congenital vascular anormality
Iatrogenic hemorrhage (sucktioning, infusing, ventilating)
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PVH / IVH
Most common neonatal intracranial hemorrhage
Occurs primarily in premature infants
Incidence is inversely proportional with birthweight:
60~70% of 500- to 750-g infants, 10~20% of 1000- to 1500-g infants
Occasionally seen in near-term and term infants
Rarely present at birth
50% on the 1st day, 80~90% between birth and the 3rd day
20~40% progress during the 1st week
Delayed hemorrhage after the 1st week in 10~15% of the cases
New-onset IVH is rare after the 1st month of life regardless of the birthweight
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Pathogenesis of PVH / IVH
Gelatinous subependymal germinal matrix
at periventricular area
Embryonal neurons and fetal glial cells
Immature blood vessels of germinal matrix: thin walls for their relatively large size, lack of a m