Treatment of cerebral hemorrhage in a newborn child. Intracerebral hemorrhages in premature newborns: consequences, treatment, prognosis Suspicion of cerebral hemorrhage in newborns

Brain hemorrhage in newborns is a serious pathology that develops as a result of damage to the vessels of the dura mater or rupture of a cerebral vessel. This often happens with birth injuries. According to statistics, intracranial hemorrhage (ICH) occurs in 1 in 1000 cases in full-term infants. 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 complications such as neurological pathologies, hydrocephalus, cerebral palsy, cerebral edema, visual impairment, motor activity, speech apparatus and even death. It all depends on the degree of hemorrhage, its location, general condition infant and compensatory abilities of the brain.

Causes

As we have already found out, very premature 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 pregnancy. The fact is that during this period the periventricular space is literally penetrated by a large number of vessels, which play an important role at this stage, but over time cease to be functional. If complications arise and there is a 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:

• lack of vitamin K and K-dependent factors, other anomalies associated with the coagulation process (blood clotting);
• pathologies due to severe hypoxia: acidosis, too strong activation of fat peroxidation, low blood pressure;
• intrauterine infections with viruses, mycoplasmas that contribute to the destruction of vascular walls;
• chronic diseases mothers (for example, diabetes);
• the influence of a woman’s harmful habits (tobacco smoking, alcoholism);
• injuries during childbirth due to narrow birth canal and a large fetal head, during rapid labor, caesarean section;
• use of obstetric aids (vacuum extraction of the fetus, obstetric forceps).

Types and extent of damage

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

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

Subarachnoid hemorrhage is said to occur when a vessel ruptures in the space between the arachnoid and soft membrane. If blood fills one or more ventricles, we are talking about intraventricular hemorrhage (hereinafter abbreviated as IVH). Another epithelial layer that protects the brain is called 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:

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

According to the ICD-10 classification, hemorrhages are divided as follows:

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

Various diagnostic formulations sometimes confuse the correct diagnosis, so when deciding on a treatment regimen, the doctor is guided by the results of an ultrasound, MRI or X-ray examination.

Signs of a brain hemorrhage do not always appear immediately. The pathology may be asymptomatic for the first day

Symptoms

The clinical picture will differ slightly depending on the location of the vascular damage, but in general, characteristic features hemorrhages in infants:

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

Now let us characterize the clinical picture in individual situations:

SEC

One of the most common forms of hemorrhage. SEC does not have any specific symptoms. Its most important manifestation is considered to be repeated attacks of apnea in the first days of a newborn’s life. The 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 eyeballs and in symptoms of depression/arousal in mild degree. As a result of SEC, a cyst often forms.

Intraventricular hemorrhage in newborns

With hemorrhage into the ventricles of the brain of grades 1 and 2, there are no visible symptoms and can pass without the development of neurological pathologies. However, in more severe cases, swelling of the fontanelles, convulsions, disruptions in breathing and of cardio-vascular system. Then lethargy sets in, reflexes and motor activity are inhibited, and the head may increase in size.

All this occurs due to an increase in liquid volume, a sharp increase intracranial pressure and, as a result, swelling of the brain and compression of the nerve centers responsible for various work in our body.

If blood ruptures 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. The symptoms have 2 phases: convulsions and a decrease in all reflexes and organ functions until loss of consciousness, then “clearance” occurs.

With subdural hemorrhage, the picture is almost the same, so differences can only be made using diagnostic methods.

Subarachnoid

As in previous cases, clinical picture very variable. For the first 2-3 days there may not be any visible disturbances. Then the processes of excitation/depression alternate. Even with the development of seizures in the intervals between them, the child looks completely healthy. The prognosis and need for treatment will again depend on the extent of the lesion.

Diagnosis and treatment

The diagnosis is made based on the results of ultrasound examination through the fontanel and computed tomography, and also judging by blood tests.

Treatment of the acute phase is carried out in special conditions while maintaining the required temperature regime and ventilation. Therapy is aimed at reducing intracranial pressure and reducing brain swelling. At the same time, it is necessary to maintain cerebral blood flow.

Using CT, you can see the extent of hemorrhage and its location

If this treatment does not produce results, surgical intervention is indicated: bypass surgery.

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

Prevention

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

The birth of a child is a complex, responsible and often unpredictable process. Sometimes it happens that as a result of childbirth, the baby receives severe injuries, in particular, birth injuries to the central nervous system. What are the reasons for such unpleasant consequences of childbirth in newborns? And will he give positive result timely treatment started?

Causes of hemorrhages in infants

Brain hemorrhage or intracranial bleeding in a baby is caused by a rupture inside the skull blood vessels. This could be caused by damage to his skull or lack of oxygen.

The prerequisites for hemorrhage are:

• post-term or premature pregnancy;
• discrepancy between the size of the newborn’s head and the size of the birth canal;
• severe pregnancy (hypoxia, intrauterine infections);
• protracted or, conversely, rapid labor;
• incorrect interventions by obstetricians.

Types of cerebral hemorrhages in an infant

Depending on where in the children’s brain the blood vessels ruptured, the following are distinguished:

Epidural hemorrhages

Such intracranial bleeding occurs in newborns if the vessels between the bones of the skull and the dura mater are damaged. The phenomenon is observed when the bones of the cranial vault are damaged. Its symptoms are:

• on the damaged side there is dilation of the pupil;
• slow heartbeat;
• low blood pressure;
• suffocation;
• convulsions.

Epidural intracranial bleeding in newborns is characterized by the presence of a quiet interval for 3-6 hours, then brain compression syndrome occurs, and the baby suddenly becomes worse. Just a couple of days later the consequences are the worst: he falls into a coma, and even appropriate treatment does not help.

Subdural hemorrhages

Such intracranial bleeding in newborns occurs when the vessels between the soft and hard membranes of the brain are damaged. They usually occur as a consequence of rapid or prolonged labor of a very large fetus. In this case, damage and displacement of the skull plates is possible. Currently, it is quite rare in newborns, thanks to the advanced delivery method. The consequences depend on how quickly the injury was diagnosed, its causes were established and treatment began. This type of pathology can lead to a heavy load on the surface of the brain, which in turn leads to the development of various neurological disorders or a greatly increased level of bilirubin in the blood.

Subarachnoid hemorrhages

The most common type of hemorrhage in newborns. It usually occurs in premature babies when blood vessels rupture in the space between the arachnoid membrane and the substance of the brain. They can be triggered by prolonged labor with obstetric intervention. With this pathology, inflammation of the membranes of the brain occurs, which is usually caused by the breakdown products of blood that has settled on them.

Signs appear literally immediately or a few days after the birth of premature babies.

Subarachnoid hemorrhage has the following symptoms:

• general excitement of the baby;
• constant screaming, sleep disturbance;
• a newborn lying for a long time with his eyes open;
• anxious, wary expression on the baby's face;
• violent reaction at the slightest irritation;
• an increase in head circumference caused by divergence of the skull bones;
• tension in the neck muscles;
• strabismus, convulsions.

With this type of brain damage in premature newborns, the degree of consequences is insignificant. Their condition will soon return to normal if treatment is started in a timely manner.

Hemorrhages into the brain and ventricles

Intraventricular hemorrhage in a newborn occurs in the ventricles, i.e. cavities of the brain filled with cerebrospinal fluid. It usually occurs in very premature newborns who have slow intrauterine brain development. Typically, the risk group includes children born before the 32nd week of pregnancy. This type of bleeding inside the skull usually goes away in the first three days of a newborn's life and does not cause any major consequences. If more happens serious damage vessels, as a result of which the ventricles are completely filled with blood, then this is associated with particularly dangerous complications such as behavior problems or cerebral paralysis, even if treatment is started in a timely manner.

Symptoms of hemorrhage

In premature newborns born with pathology, several types of hemorrhages can often be combined. But depending on the severity of the brain damage, among the many symptoms, the symptoms of one of them are most pronounced.

Typically, all children who have some kind of damage to the blood vessels in the cerebral cortex are very slow, lethargic and apathetic. They have problems with feeding.

At proper care, if correct treatment is carried out, cerebral hemorrhages in young children do not cause very big problems. Although, of course, the result of recovery depends on many factors, including:

• degree of brain damage in premature newborns;
• degree of disease;
• infections and diseases that children have and the degree of complexity of their course.

To ensure that a newborn born with such a pathology does not experience any deviations in the future and can develop at the level of his peers, he needs to be provided with proper treatment and a development-stimulating environment already in the first years of life.

The birth of a child is a complex and difficult process, and it can end quite unpredictably. One of the most severe injuries to the central nervous system is cerebral hemorrhage in children. This unpleasant phenomenon can occur due to various reasons and the result of the therapy is not always favorable.

The sooner such a disorder is diagnosed in a child and prescribed effective treatment, the higher the chance that the consequences of a cerebral hemorrhage in a newborn will not disrupt the normal functioning of the child’s body.

Any bleeding is the result of a pathological condition such as vascular rupture. Most often it occurs when the still immature cranial bones of a small child are damaged and due to fetal hypoxia. Most often, cerebral hemorrhage occurs in children born ahead of schedule. Among babies born with a body weight of less than 1500 g, almost every second one is diagnosed with this pathology.

Brain hemorrhages are less common in babies born at full term. Medical practice shows that only one in 1000 is diagnosed with this condition.

Experts identify some factors, the impact of which on a child’s body can provoke cerebral hemorrhage:

1. prematurity or, conversely, birth after term
2. large size of the child’s head and its inconsistency with the birth canal
3. labor is too rapid or, conversely, a protracted process
4. unqualified actions of doctors

Brain hemorrhage in a child can result from a difficult pregnancy. This means that such a pathology can develop after intrauterine damage to the fetus by various infections or during hypoxia. Often the cause of the disorder is toxicosis in the second half of pregnancy, and sometimes the baby is diagnosed with two types of hemorrhage at once.

Each type of hemorrhage is characterized by the appearance of the same first symptoms:

• convulsions
• vomiting attack
• headache pain
• child's lethargy and low activity

Typically, such symptoms develop in a child completely unexpectedly and most often while he is awake. Each such manifestation allows specialists to assess the location of the hemorrhage, so it is necessary to carefully monitor the child and remember his condition.

Types of pathology

There are several types of cerebral hemorrhages in newborns, and they are determined by the location where the blood vessels ruptured.

Epidural hemorrhages

This type of hemorrhage is usually detected in those babies who have suffered damage to the vessels located between the dura mater and the bones of the skull.

With this pathological condition, the following symptoms usually appear:

• the pupil on the injured side dilates
• heartbeat slows down
• blood pressure decreases
• troubled by attacks of suffocation
• convulsions occur

With epidural bleeding in newborns, there is usually a calm period of several hours, after which brain compression syndrome develops, and the child’s condition sharply worsens. After about a few days, the child falls into a coma, and no treatment brings a positive result.

Subdural hemorrhages

This type of bleeding develops in a child when the vessels located between the hard and soft membranes of the brain are damaged. Most often, this pathological condition occurs when the baby is too heavy, as well as when labor is too long or too fast.

A common cause of subdural bleeding is considered to be damage or displacement of the bones of the skull, but this type of pathology is not diagnosed so often today, since the improvement of labor techniques allows timely measures to be taken.

The risk of developing this type of hemorrhage is too high in those babies who are born outside the maternity hospital without the necessary obstetric care.

With this pathological condition, the following symptoms are usually observed:

• strabismus due to deviation of the eyeballs
• coma state
• stiff neck muscles
• lack of reaction to bright light

It is important to remember that the baby’s life depends on the correct diagnosis in the future. In a situation where medical assistance is provided too late, the consequences may be pathologies of the nervous system and other disorders. With subdural hemorrhage, the condition is usually severe from the moment the child is born, and if treatment is not provided medical care death is possible 2 days after birth.

Subarachnoid hemorrhage

The main reason for the development of such hemorrhage is prolonged labor and unqualified medical assistance.Mostly subarachnoid hemorrhage is detected in children born prematurely due to rupture of blood vessels between the cerumen and the arachnoid membrane.

With this pathological condition, the following symptoms appear:

• convulsions
• divergence of cranial bones
• negative reaction to any irritation
• trouble sleeping, meaning the eyes are constantly open
• the baby is too excited and constantly screaming

Typically, such manifestations occur immediately after childbirth or a few days later. With this type of hemorrhage, it is possible to avoid unpleasant consequences in the future, provided that treatment is started in a timely manner.

Parenchymal and intraventricular hemorrhage

The severity of symptoms in intraventricular and parenchymal hemorrhage is determined by the degree of filling of the ventricles.

Medical practice shows that this type of hemorrhage most often occurs in children born prematurely.

Such babies are characterized by slow development of the central nervous system and are born before 32 weeks. If the ventricles are not completely filled and their sizes are not increased, then damage occurs after a few days.

When the ventricles are completely filled and enter the brain substance, as well as when the onset is too late drug therapy, possible development of cerebral palsy. In addition, various psychical deviations, but their signs become noticeable much later.

Possible complications and consequences

The peculiarity of the brain of a newborn child is the fact that it has excellent self-healing abilities. With minor conduct and appointment proper treatment it is possible to completely get rid of the pathology.

In addition, in the future the child will not experience negative consequences of hemorrhage, but full recovery may take from several months to 2 years.

Unfortunately, the prognosis is not always favorable and with serious brain damage the following complications may develop:

• hydrocephalus
• epilepsy
• developmental delay

In addition, death cannot be ruled out as a consequence of cerebral hemorrhage.

Diagnosis and treatment methods

Such an unpleasant diagnosis as cerebral hemorrhage is made to the child in the maternity hospital by neonatologists, and subsequently the baby is monitored by a neurologist. A specialist may suspect a pathology based on some external signs, but additional examinations may be necessary to confirm the diagnosis.

The child may be prescribed the following diagnostic procedures:

• CT scan
• blood analysis
• coagulogram
• cerebrospinal fluid examination

Often, several types of hemorrhages are diagnosed in newborns, but there is no single treatment regimen. This or that therapy is selected taking into account the type of pathology, the symptoms that appear and the degree of brain damage.

The main task acute period is to restore the functioning of the central nervous system, breathing and heart. In addition, the treatment involves the restoration of metabolic processes in the child’s body, as well as the normalization of blood circulation and the functioning of the adrenal glands. If necessary, the child is given resuscitation measures.

A child with a cerebral hemorrhage requires careful care and constant monitoring from the doctors.

On the first day, the baby should be positioned so that his head is slightly elevated. A heating pad is placed near the legs, and ice is placed at a distance of 20 cm from the head.

From the video you can find out why newborns need to have an ultrasound of the brain:

During the first few days, the newborn is fed expressed milk, and if swallowing is impaired, a tube is used. After the child’s condition improves, a set of rehabilitation measures is selected. The main goal is to stimulate the central nervous system, and the following procedures are usually selected:

1. reception medicines helping to improve brain metabolism
2. gymnastic exercises
3. massage
4. speech therapy sessions for older adults

With timely treatment, there is a high chance that over time the cerebral hemorrhage will disappear without any unpleasant consequences.

Prognosis and prevention

The prognosis of the pathology depends on the severity of the disorders and with asymptomatic hemorrhage and mild neurological disorders, the outcome is favorable.

If hemorrhage occurs during labor and is accompanied by traumatic injuries, death is possible. The surviving child may in the future develop such dangerous disorders as hydrocephalus, developmental delay and cerebral palsy.Unfortunately, there are no special preventive actions which would help avoid the development of hemorrhage in the child.

Expectant mothers should be attentive to their condition during pregnancy and be sure to follow the recommendations of the gynecologist.

In addition, it is recommended to take antenatal corticosteroids, which helps avoid unpleasant consequences after premature birth. Such drugs help blood vessels withstand various loads in the first day of a child’s life.

Damage to the central nervous system occupies a leading position in the mortality rate of newborns. One of the common ailments is cerebral hemorrhage in newborns. There are cerebellar, intra- and periventricular, parenchymal, epidural and subarachnoid hemorrhages. The seriousness of the problem lies in the high probability of death and severe disability in young patients.

Hemorrhage in the brain in to a greater extent common among premature babies

The frequency of intraventricular and periventricular cerebral hemorrhages in newborn full-term infants is no more than 10%, while among premature infants weighing less than 1.5 kg, the frequency of such cases reaches 30–35%, and almost 100% in children weighing 1 kg and less. The incidence of other types of hemorrhages is very variable and does not have of great importance, because the leading cause of death in newborns is hemorrhages in the ventricles of the brain.

It turns out that when conducting a preventive mass ultrasound of the brain in apparently healthy full-term children, mild intraventricular hemorrhages are detected in 2–3%, which have no clinical manifestations.

Risk factors

A complex of several causes undoubtedly leads to cerebral hemorrhage; we list the main, most significant risk factors:

• birth injury;
• congenital oxygen deficiency, which has serious consequences in the form of decreased blood pressure and metabolic disorders;

Due to impaired perfusion in the placenta, the fetus receives oxygen-poor blood

• congenital conditions associated with blood clotting disorders (vitamin K deficiency, increased bleeding due to impaired platelet function);
• in premature infants, this is a violation of the automatic regulation of cerebral blood flow that occurs after suffering suffocation simultaneously with oxygen deficiency;
• intrauterine infections have a devastating effect on blood vessels and the brain;
• low temperature bodies;
• reduced amount of glucose in the blood;
• heart failure;
• patent ductus arteriosus;
• high risk cerebral hemorrhages in premature babies, babies with low body weight;

Premature newborn in the incubator

• medical reasons: strict artificial respiration values, rapid infusions of solutions into a vein, uncontrolled oxygen therapy, painful procedures, negligent child care, traumatic procedures, incorrect medication prescriptions;
• social reasons: children born in dysfunctional families if the mother suffers from drug addiction or alcoholism, smoked during pregnancy, or is a carrier of sexually transmitted infections.

The immediate causes of birth trauma are a discrepancy between the baby's head and the size of the mother's pelvis, which happens when large children are born and abnormalities of the mother's pelvic bones. The cause of injury can be fast (2 hours) or slow (12 hours) labor, improper application of obstetric forceps to the baby's head, pulling the baby by the head, or the use of a vacuum if the baby is born feet first. The ratio of traumatic and non-traumatic brain hemorrhages is 1:10.

Development mechanisms

Hemorrhages under the dura mater and in the cerebellar area appear as a result of birth trauma - when cracks and fractures of the bones of the cranial vault, blood vessels rupture and bleeding begins. Along with sub- and epidural hemorrhages in children, bruises (cephalohematoma), fractures of the clavicle, and traces of the application of forceps or a vacuum extractor can be seen on the head.

Circumventricular and intraventricular cerebral hemorrhages in newborns develop as a result of oxygen deficiency, which can be observed with arterial hypertension, ischemia and venous congestion of the brain, with thrombosis, blood clotting disorders.

Subarachnoid hemorrhage can occur spontaneously, either as a result of trauma or as a result of oxygen deprivation.

The result is that injuries lead to superficial hemorrhages, but dangerous hemorrhages deep in the brain are the result of hypoxia.

Symptoms

The most common manifestation of intracranial hemorrhage in newborns is a sharp deterioration in health, with the development of attacks of shortness of breath and outbreaks of hyperexcitability.

And:

• There is a change in the cry; it can be weak or very intense.

In a newborn, an intracranial hematoma may manifest as restlessness and a change in cry

• There is bulging and tension of the large fontanel.
• Celebrate eye symptoms: rolling eyes lower eyelid, chaotic movement, squint.
• Body temperature can either jump or become extremely low.
• Digestive disorders: regurgitation, vomiting, bloating, unstable stool, which leads to poor weight gain.
• May be noted rapid breathing and pulse, the hands may remain cold.
• Trembling of limbs, sudden shuddering, convulsions.
• Muscle tone disorders.
• Increasing anemia.
• Metabolic disorders, which are reflected in a biochemical blood test.

The listed symptoms vary greatly depending on whether the baby is full term or not, how large the hemorrhage is, and where it is located. The child’s condition is aggravated by the addition of pneumonia, heart failure, meningitis, systemic inflammatory reaction, and adrenal insufficiency.

Types of brain hematomas

Epidural hemorrhages

They are located between the dura mater and the superficial bones of the skull. They are characterized by a lack of consistency of symptoms. After imaginary well-being (up to 6 hours), the child becomes restless, progressive compression of the brain develops - after 1–1.5 days, coma is likely to develop. Classic symptoms: dilated pupils, convulsions, immobility of the arms and legs on one side, suffocation, low blood pressure and a low pulse.

Subdural hemorrhages

It is observed when the bone plates of the skull are displaced. It is the result of applying forceps to the baby’s head, the birth of the baby legs first, so it is rare and mainly occurs in large newborns. Localization – occipital region, crown. Symptoms of the disease develop slowly: 1–3 weeks after birth.

Hemorrhage into the cerebellum

It is difficult with severe symptoms of depression of the central nervous system and compression of the brain stem. The course depends on the timeliness of diagnosis and treatment - with early diagnosis, more than half of children have a chance of a favorable outcome.

The cerebellum is responsible for the coordination of movements

Subarachnoid hemorrhages

Occurs when meningeal vessels rupture. Symptoms of the disease develop immediately after birth, but may take several days. Mild hemorrhage may occur unnoticed, moderate and severe hemorrhage occurs with the manifestation of meningeal symptoms, intracranial hypertension, hydrocephalus.

Intraventricular hemorrhages

Symptoms have a wave-like, spasmodic course, which are subsequently replaced by deterioration or improvement of well-being. More or less volumetric hemorrhage into the ventricles of the brain manifests itself on the second day of life with anemia, bulging of the fontanelle, decreased muscle tone, motor activity, the child stops eating, shortness of breath increases, and abnormal eye movements, drop in blood pressure, rapid pulse.

Consequences

If the hemorrhage is asymptomatic, or the neurological disorders are minor, then the further prognosis is quite favorable. If the hemorrhage is extensive and was not discovered in the first days after birth, then a cyst will subsequently form, since the brain tissue inside the hemorrhage is destroyed, this can cause all sorts of neurological disorders in the child, mental and physical development delays.

The prognosis depends on the timeliness of diagnosis, treatment, location and size of the hemorrhage.

In 50% of even treated children, the ventricles subsequently dilate, which leads to the development of cerebral hydrocephalus (hydrocephalus). Complications such as ventriculitis, cerebral palsy, meningoencephalitis, and cerebrospinal fluid dynamics disorders can significantly reduce the life expectancy of young patients.

Diagnostics

If intracerebral hemorrhage is suspected, the child in the maternity hospital undergoes ultrasonography brain in standard planes of the head, through the large fontanel. In more unclear cases, CT scan helps confirm the diagnosis.

Treatment

Newborn children with cerebral hemorrhages are under strict medical supervision under protective conditions. Child care is carried out gently and carefully, any procedures are performed as carefully as possible so as not to cause pain and discomfort to the child.

Children are fed through a bottle; sucking milk from the breast is unsafe due to physical activity, children in serious condition are fed through a tube and droppers.

Treatment is carried out according to the main symptoms:

• To stop bleeding, Etamzilat and Vikasol are administered.
• For convulsions - Phenobarbital.
• For cerebral edema - Diacarb, Mannitol.
• According to indications, nootropics, antibiotics, vascular medications, and electrolytes are prescribed.

With increasing hemorrhage, massiveness of the process with displacement of the ventricles and other brain structures, neurosurgical treatment is carried out; 30–40% of children need it. Among surgical methods Lumbar and ventricular punctures are used, blood is suctioned from hemorrhage sites, and liquor shunt tubes are installed. A third of patients after surgical treatment is recovering.

Treatment if necessary intracranial hematomas performed surgically

The appearance of a child in a family is associated with new, previously unknown difficulties, which can sometimes be completely unpredictable and even dangerous. The reasons for this are different, the outcome is not always favorable. However, than earlier illness will be diagnosed, the sooner his treatment begins, the more chances the baby has to be healthy and happy.

Cardiologist

Higher education:

Cardiologist

Kabardino-Balkarian State University them. HM. Berbekova, Faculty of Medicine(KBSU)

Level of education – Specialist

Additional education:

"Cardiology"

State educational institution "Institute for Advanced Medical Studies" of the Ministry of Health and Social Development of Chuvashia

It is believed that stroke is an “age-related” disease and mainly affects older heart patients. But high percent deaths and disabilities after childhood stroke brings the problem to the forefront medical practice. It is not easy to identify pathology in children, and they need help literally in the first hours of the development of disorders of the blood supply to the brain. It is extremely important for parents to know alarming symptoms stroke to prevent negative consequences.

Brain catastrophe in children

Brain catastrophe can occur at any age, even during fetal development. A number of signs distinguish childhood stroke from disorders of the blood supply to the brain in adults. In children:

• the condition is more often diagnosed when blood vessels in the brain rupture;
• local neurological symptoms predominate (in adults – cerebral);
• the pathology is characterized by difficulty in diagnosing (patients have no obvious symptoms for up to a year);
• microstrokes and lacunar cerebral necrosis often occur with minimal signs of damage;
• recovery of neurological changes occurs faster.

In terms of general symptoms, the pathology in adults and infants manifests itself almost identically.

Types of pathology

As in adult patients, stroke in children is characterized by a sudden disruption of blood circulation. According to the causes of development, several forms of stroke are distinguished:

• hemorrhagic - accumulation of blood spilled from blood vessels in the brain;
• ischemic – thrombotic blockage of the lumen of a cerebral vessel;
• combined – occlusion of cerebral vessels, complicated by hemorrhages. Rarely observed, extremely dangerous.

Disruption of blood flow in the vessels of the brain has two periods of development:

• perinatal (from 28 weeks of intrauterine development to 1 month of a newborn’s life);
• juvenile (in a child from one month to 18 years).

Perinatal stroke is diagnosed more often.

Age specifics

The causes of the development of pathology and its symptoms depend on the age of the child.

Age-related features of stroke development

Hemorrhagic juvenile stroke can be fatal.

Stroke: features of types

Ischemic and hemorrhagic strokes differ in their manifestations and causes. The treatment of these types of pathologies also has its own subtleties.

Features of ischemic and hemorrhagic types of stroke

In newborns, with proper care, the consequences of cerebral hemorrhages do not lead to significant problems. But recovery is influenced by various factors, including proper rehabilitation.

General principles of treatment

To provide first aid, a number of actions are carried out:

1. Lay the child down, raising his head;
2. Open the windows to ensure sufficient air access;
3. Unfasten or remove tight clothing;
4. If vomiting or convulsions occur, turn your head to one side and, if necessary, clean your mouth;
5. Call a medical team;
6. If breathing stops, perform resuscitation.

All activities should be carried out quickly and clearly; the child’s further recovery depends on this. Basic therapy is carried out in a hospital and eliminates the danger to the child’s life:

• normalizes blood pressure and heart rhythm;
• localizes cerebral edema;
• restores metabolic processes;
• relieves cramps and pain.

The main therapy depends on the type of stroke.

Rehabilitation measures

Restorative measures follow after the acute phase of a stroke. They are carried out in two stages:

• The first is based on doctor’s orders, proper nutrition, maintaining peace. Therapeutic massages, physiotherapy, exercise therapy are indicated. Then the rehabilitation process includes sessions with a rehabilitation therapist, speech therapist, and psychologist;
• the second is developed individually. Its duration depends on the severity of neurological disorders.

The best option for the second stage is for the child to be in a rehabilitation center. Using the necessary medical equipment, medical staff will help restore:

• motor skills (teaching aids);
• muscle tone, motor coordination (massage, exercise therapy, electrical stimulation, paraffin applications);
• speech (exercises with a neuropsychologist, speech therapist, course massage of the hands);
• mental activity (taking neurotrophic drugs, nootropics).

Children recover faster after a stroke than adults. The functions of dead neurons are taken over by other brain cells. This is a slow and difficult process, but it is much easier for babies to regain lost functions.