国家级精品课程华中科技大学《儿科学》新生儿颅内出血课件.ppt

Intracranial Hemorrhage of the Newborn Etiology and Epidemiology of ICH Trauma (epidural, subdural, or subarachnoid) fetal head is too large in proportion to the size of the pelvic outlet prolonged labor/breech or precipitate deliveries Mechanical assistance with delivery Asphyxia/Hypoxic ischemic encephalopathy Premature infants (peri-/intraventricular hemorrhage, PVH/IVH) Primary hemorrhagic disturbance (subarachnoid or intracerebral) DIC isoimmune thrombocytopenia neonatal vitamin K deficiency (maternal phenobarbital or phenytoin) Congenital vascular anomaly Iatrogenic hemorrhage (sucktioning, infusing, ventilating) Incidence of PVH/IVH Most common neonatal intracranial hemorrhage Occurs primarily in premature infants Incidence increases with decreasing 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% occur on the 1st day, 80~90% occur between birth and the 3rd day 20~40% progress during the 1st week Delayed hemorrhage may occur 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 (periventricular) Embryonal neurons and fetal glial cells Immature blood vessels and highly vascular area Poor tissue vascular support Predisposing factors or events Prematurity, RDS, Hypoxic-ischemic or hypotensive injury, reperfusion, increased or decreased CBF, pneumothorax, hypervolemia, hypertension, etc Periventricular leukomalacia (PVL) Prenatal or neonatal ischemic or reperfusion injury Necrosis of the periventricular white matter Damage to the cortico-spinal fibers in the internal capsule Pathogenesis of PVH/IVH Intravascular factors Fluctuating cerebral blood flow (related to mechanics of ventilation) Increasing in CBF (pressure-passive cerebral circulation in premature infants) Increases in cerebral venous