文档介绍：IntracranialHemorrhageoftheNewborn
EtiologyandEpidemiologyofICH
Trauma(epidural,subdural,orsubarachnoid)
fetalheadistoIntracranialHemorrhageoftheNewborn
EtiologyandEpidemiologyofICH
Trauma(epidural,subdural,orsubarachnoid)
fetalheadistoolargeinproportiontothesizeofthepelvicoutlet
prolongedlabor/breechorprecipitatedeliveries
Mechanicalassistancewithdelivery
Asphyxia/Hypoxicischemicencephalopathy
Prematureinfants(peri-/intraventricularhemorrhage,PVH/IVH)
Primaryhemorrhagicdisturbance(subarachnoidorintracerebral)
DIC
isoimmunethrombocytopenia
neonatalvitaminKdeficiency(maternalphenobarbitalorphenytoin)
Congenitalvascularanomaly
Iatrogenichemorrhage(sucktioning,infusing,ventilating)
IncidenceofPVH/IVH
Mostcommonneonatalintracranialhemorrhage
Occursprimarilyinprematureinfants
Incidenceincreaseswithdecreasingbirthweight:
60~70%of500-to750-ginfants,10~20%of1000-to1500-ginfants
Occasionallyseeninnear-termandterminfants
Rarelypresentatbirth
50%occuronthe1stday,80~90%occurbetweenbirthandthe3rdday
20~40%progressduringthe1stweek
Delayedhemorrhagemayoccurafterthe1stweekin10~15%ofthecases
New-onsetIVHisrareafterthe1stmonthofliferegardlessofthebirthweight
PathogenesisofPVH/IVH
Gelatinoussubependymalgerminalmatrix(periventricular)
Embryonalneuronsandfetalglialcells
Immaturebloodvesselsandhighlyvasculararea
Poortissuevascularsupport
Predisposingfactorsorevents
Prematurity,RDS,Hypoxic-ischemicorhypotensiveinjury,reperfusion,
increasedordecreasedCBF,pneumothorax,hypervolemia,hypertension,etc
Periventricularleukomalacia(PVL)
Prenatalorneonatalischemicorreperfusioninjury
Necrosisoftheperiventricularwhitematter
Damagetothecortico-spinalfibersintheinternalcapsule
PathogenesisofPVH/IVH
Intravascularfactors
Fluctuatingcerebralbloodflow(relatedtomechanicsofventilation)
IncreasinginCBF(pressure-passivecerebralcirculationinprematureinfants)
Increasesincerebralvenouspressure
DecreasesinCBF(occurringprenatallyorpostnatally)
Plateletandcoagulationdisturbances(hypercoagulablestate,vitami