新生儿颅内出血Intracranial-Hemorrhage-of-the-Newborn.ppt

Intracranial Hemorrhage of the Newborn( ICH ) Contents mastered :The main causes of neonatal ICHThe mechanism of PVH-IVH Classification and manifestation of PVH-IVHDiagnosis of neonatal ICH Prevention of neonatal ICH A severe disease in neonateRelated to perinatal asphyxia and trauma, and maturity of fetusThere are four major types Subdural hemorrhage Primary subarachnoid hemorrhage Intracerebellar hemorrhage Periventricular-intraventricular hemorrhage (PVH-IVH) Introduction Etiology and Epidemiology of ICH Trauma (epidural, subdural, or subarachnoid)fetal head is too large compared with the size of the pelvic outletprolonged labor/breech or precipitant deliveriesDelivery 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)DICisoimmune thrombocytopenianeonatal 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 infantsIncidence 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 birth50% on the 1st day, 80~90% between birth and the 3rd day20~40% progress during the 1st weekDelayed 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 / IVHGelatinous subependymal germinal matrix at periventricular areaEmbryonal neurons and fetal glial cellsImmature blood vessels of germinal matrix: thin walls for their relatively large size, lack of a muscularis layerPoor extravascular support: immature interendothelial junctions Predictive factors or eventsPrematurity, RDS, Hypoxic-ischemic or hypotensi