新生儿颅内出血(Intracranial-Hemorrhage-of-the-Newborn).pptVIP

Intracranial Hemorrhage of the Newborn( ICH ) 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 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) 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 BW1500g 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) 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 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 muscularis layer Poor extravascular support: immature interendothelial junctions Predictive factors or events Prematurity, RD