Intracranial hemorrhage in newborns, symptoms and treatment
The main cause of intracranial hemorrhage is birth trauma, leading to rupture of vessels or damage to their walls. Predicting conditions include softness and suppleness of the bones of the skull, strong contractions of the uterus, tender meninges, hypoprothrombinemia in the first days after birth, poor kidneys of the newborn with vitamin K, as well as features of the blood coagulation system in the first days after birth, tenderness and fragility of blood vessels. Hemorrhages arise epi- and subdural, subarachnoid, intraventricularly into the brain substance, as well as simultaneously in several parts of the central nervous system.
Symptoms of .Intracranial hemorrhages, especially common, cause serious disorders in the child's body immediately after his birth. Clinical symptomatology is very diverse. However, we can distinguish one group of symptoms characteristic of hemorrhages above the brain nerve, the brain substance and the meninges, and the other for hemorrhages below the cerebellar nerve and in the cerebral ventricles.
The first group of symptoms include child's anxiety, frequent screaming, yawning. He performs multiple, like automatic, movements with his hands and feet. Sometimes a large fontanel is tense. Characteristic tonic-clonic seizures are common or separate muscle groups. In a number of cases, there are strabismus, ptosis, pronounced nystagmus. Skin and tendon reflexes are increased. The intensity and location of seizures indicate a localized lesion of the central nervous system. Thus, on the side of the lesion, marked cramps of the eyelids are observed, while the convulsions of the limbs are more pronounced on the opposite side. There are attacks of asphyxia, accompanied by cyanosis and respiratory disorders, as well as a decrease in heart rate.
After 4-5 days all symptoms either disappear( the general condition of the child becomes satisfactory), or the period of oppression of the nervous system and paralysis begins. In the second case, general weakness, lethargy, drowsiness, refusal of food, a weak reaction to external stimuli, slow and arrhythmic breathing, a change in cyanosis with a sharp blanching and, on the contrary, paresis and paralysis of separate muscle groups are revealed. Gradual progression of these symptoms leads to a coma.
The clinical picture of hemorrhages of the second group is much harder. The phases of irritation usually do not happen, and immediately symptoms of depression are observed. Breath intermittent with frequent stops, cyanosis, grasping the air with your mouth. Children are listless, with confused consciousness. Muscle tone is low, rarely elevated. Eyes are wide open, they are directed into the distance. Usually there are no swallowing and sucking reflexes. Bradycardia. The coma is rapidly developing. Often there is hyperthermia. In premature infants, clinical symptoms are erased, but the general condition is much harder.
For the diagnosis of intracranial hemorrhages, an obstetric anamnesis and the condition of the child immediately after birth are important.
Taken during puncture, cerebrospinal fluid must be examined for the presence of blood, since its admixture indicates a hemorrhage. In this case, it is necessary to differentiate the blood, accidentally caught in puncture due to wounding of blood vessels. Blood due to cerebral hemorrhage is evenly mixed with the liquid. With a hemorrhage, the liquid after centrifugation has a yellowish tinge and the sediment contains not only fresh, but also leached red blood cells. The prognosis depends on the size and localization of hemorrhages, in particular, it is bad for hemorrhages below the cerebellar nest. In children with intracranial hemorrhages, pneumonia often occurs.
Treatment of .They take measures to stop the bleeding. The child is provided with absolute peace. It is laid so that the head and upper part of the trunk are raised. Do not allow the child to cool, in connection with which it is well wrapped, put warmers at the feet. At some distance from the head, an ice pack is placed. Immediately intramuscularly administered 5 mg of vitamin K( can be re-introduced), 5 ml of a 10% solution of calcium gluconate with 200 mg of ascorbic acid;intravenous plasma or fresh blood at a rate of 5-10 ml per 1 kg of body weight. Blood transfusions are performed in accordance with the general condition of the child, starting from the 2-3rd day of life. Repeated transfusions are allowed. Given the possibility of metabolic acidosis, intravenously injected 4-5 ml / kg 1-4% sodium bicarbonate solution. With convulsions and severe anxiety appoint 0.005 g of phenobarbital 2 times a day, an enema of chloral hydrate( 0.25 g in 10 ml of mucous solution) or 25% solution of magnesium( 0.5-1 ml intramuscularly);largaktil or plegomazin at the rate of 2 mg per 1 kg of body weight per day or 0.5% solution of aminazine( 0.2-0.3 ml) intramuscularly;1% solution of glutamic acid 1 teaspoon 3 times a day.
With a sharp tension of the fontanelles, convulsions, with a roll-over of the head, a spinal puncture is produced with a slow release of the cerebrospinal fluid( several milliliters) dropwise. It should be remembered that spinal puncture without signs of increased intracranial pressure can exacerbate or cause a new hemorrhage. To prevent pneumonia, antibiotics of a wide spectrum of action are prescribed. Oxygen therapy is carried out with increasing cyanosis, cardiac agents are used to reduce cardiac activity.
In the first days of a child's life, they are fed a expressed mother or donor breast milk through a catheter.
Women's magazine www. BlackPantera.en: S. Shamsiev