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Neonatal Intracranial Hemorrhage

Intracranial Hemorrhage in Fetus or Newborn


Presentation

  • In the present study, the most frequent form of ICH in neonates was SDH. Focal seizures, disturbed consciousness level, tense anterior fontanel, unexplained anemia, and respiratory distress were the major presenting signs.[ncbi.nlm.nih.gov]
  • The male neonate presented with poor respiratory effort, decreased muscle tone, and pallor at birth. He developed generalized seizures on day 1 of life.[ncbi.nlm.nih.gov]
  • All women presenting with postpartum hemorrhage should have a bleeding work-up to determine whether an inherited bleeding disorder such as hemophilia or von Willebrand disease is present.[hemophilia.org]
  • Germinal matrix hemorrhage can only occur when the germinal matrix is present and is therefore only seen in premature infants.[radiopaedia.org]
  • In relation to the symptoms of presentation, 10/31 presented seizures, 7/31 apnea and 2/31 multiorgan failure, requiring mechanical ventilation connection 13/31 patients.[omicsonline.org]
Neonatal Hemorrhage
  • Clinical characteristics, risk factors, and outcomes associated with neonatal hemorrhagic stroke: a population-based case-control study [published online January 17, 2017].[neurologyadvisor.com]
  • Whereas neonatal hemorrhage is a relatively common occurrence, affecting 40% to 60% of infants delivered before 32 weeks of gestation, fetal intracranial hemorrhage is quite rare.[mhmedical.com]
Noncompliance
  • The sample size of 1038 pregnancies was based on an intracranial hemorrhage rate of 20 percent in the placebo and less than 12 percent in the phenobarbital group; 90 percent power; a 5 percent two-tailed type 1 error; and an 8 percent noncompliance rate[clinicaltrials.gov]
Neonatal Seizures
  • Neurologic manifestations like neonatal seizure, decreased level of consciousness, increased intracranial pressure are the most common presentations of ICH in term newborns.[intechopen.com]
  • Signs and symptoms of intracranial hemorrhages Symptoms of intracranial hemorrhages in infants will vary based on the type and severity of the bleed, but include the following: Lethargy Neonatal seizures Apnea Feeding difficulties Irritability Bulging[abclawcenters.com]
Neurologic Manifestation
  • The most common neurological manifestations included focal seizures, disturbed consciousness level, and tense anterior fontanel. The most common general manifestations included pallor, respiratory distress, and bleeding from other sites.[ncbi.nlm.nih.gov]
  • Neurologic manifestations like neonatal seizure, decreased level of consciousness, increased intracranial pressure are the most common presentations of ICH in term newborns.[intechopen.com]
Ocular Bobbing
  • Clinical findings included multiple ecchymoses, gastric hemorrhage, hematuria, a tense fontanelle, head circumference at the 95th percentile, hypotonia, and ocular bobbing and nystagmus.[pediatricneurologybriefs.com]
Motor Disturbances
  • A major motor disturbance occurred in 16% of patients; their Ct scans showed evidence of brain destruction involving enlargement of a lateral ventricle, porencephaly, or focal atrophy.[ncbi.nlm.nih.gov]
Focal Seizure
  • Focal seizures, disturbed consciousness level, tense anterior fontanel, unexplained anemia, and respiratory distress were the major presenting signs.[ncbi.nlm.nih.gov]

Workup

Hematocrit Decreased
  • Hematocrit decreased from 29% at birth to 15% at 6 hours of age. Prothrombin time was 100 sec. Cranial ultrasound showed hemorrhage in the tentorium and hydrocephalus. CT also revealed a large cerebellar hemorrhage.[pediatricneurologybriefs.com]
Prothrombin Time Normal
  • The clinical manifestations and clinical findings vary widely, ranging from asymptomatic to life-threatening bleeding, including intracranial hemorrhage (ICH), with prolonged prothrombin time, normal partial thromboplastin time and normal platelet counts[dovepress.com]

Treatment

  • Maternal bacterial infection and bed rest may trigger deep-vein femoral thrombosis in women with a homozygous Leiden mutation on tocolytic therapy for the treatment of premature labor.[ncbi.nlm.nih.gov]
  • Sidiropoulos D, Straume B: The treatment of neonatal isoimmune thrombocytopenia with intravenous immunoglobin (IgG iv). Blut 1984;48:383-386.[karger.com]
  • His parents required termination of all treatments, and the neonate unfortunately died shortly after. Through clinical experience from this case, we believe that bromadiolone can be passed down to the fetus via placenta.[ncbi.nlm.nih.gov]
  • NHF under no circumstances recommends particular treatment for specific individuals, and in all cases recommends that you consult your physician or local treatment center before pursuing any course of treatment.[hemophilia.org]
  • Focused on treatment: key points boxes pick out the most important information for the busy specialist. Evidence-based information: extensively referenced with the latest and most important papers and articles.[books.google.com]

Prognosis

  • Treatment and prognosis The ideal treatment is the prevention of premature delivery.[radiopaedia.org]
  • The prognosis for subdural hemorrhage is guarded, but some neonates do well.[merckmanuals.com]
  • Cerebellar hemorrhage is rare, associated with poor prognosis and is seen as an echogenic area within the cerebellum with non-visualization of the 4th ventricle.[sonoworld.com]
  • Grading of severity uses a similar scale to that for neonatal intraventricular hemorrhage (IVH), with prognosis being quite poor for most cases of Grades III or IV IVH.[mhmedical.com]
  • Intraventricular hemorrhage and brain injury in the premature infant: diagnosis, prognosis and prevention. Clinics in perinatology 1989;16(2):387-411.[uichildrens.org]

Etiology

  • The possible etiologic roles of infection and bed rest are discussed in connection with a case of maternal homozygous Leiden mutation leading to prematurity, maternal deep-vein thrombosis and neonatal intracranial hemorrhage in a heterozygous premature[ncbi.nlm.nih.gov]
  • Abstract Knowledge of the timing and course of neonatal intracranial hemorrhage is essential in determining the etiology of hemorrhage, since the key to preventing neurologic damage in newborns is to define preventable causes and to treat the complications[ncbi.nlm.nih.gov]
  • Maternal salicylate ingestion should be considered in the etiology of neonatal intracranial hemorrhage without birth trauma. The infant’s relatively low salicylate level is not inconsistent with chronic toxicity.[pediatricneurologybriefs.com]
  • 3: Etiology of ICH in term new-borns.[omicsonline.org]
  • In many cases, the etiology of the hemorrhage is unknown. [2][emedicine.medscape.com]

Epidemiology

  • Summary Epidemiology The incidence has been estimated at 1/800 to 1/1 000 live births. Clinical description NAIT has been considered to be the platelet counterpart of Rh Haemolytic Disease of the Newborn (RHD).[orpha.net]
  • Standardizing the structure of stroke clinical and epidemiologic research data: the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Common Data Element (CDE) project. Stroke. 2012;43(4):967-973.[neurologyadvisor.com]
  • The aim of this study is to analyze the etiological factors, evolution and neurological prognosis of term new-borns affected by intracranial hemorrhage and epidemiological data associated with our series, in order to understand better the clinical characteristics[omicsonline.org]
  • "Traumatic Brain Injury: Definition, Epidemiology, Pathophysiology" Emedicine.com. Retrieved on June 19, 2007. Vinas FC and Pilitsis J. 2006. "Penetrating Head Trauma."[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of ICH is complex. Some cases of ICH may be attributable to the hyperperfusion that follows a period of ischemia in the immature brain during which cerebral flow autoregulation is not fully developed.[ahcmedia.com]
  • “Collectively, evidence suggests NHS pathophysiology involves rare events occurring in uniquely susceptible individuals rather than any controllable external factors, limiting opportunities for prevention,” the researchers concluded.[neurologyadvisor.com]
  • Lesions which occur in the periventricular white matter occur in 3-10% of infants with birth weight Pathophysiology As the name implies, PVH originate in the tissue abutting the lateral ventricle, e.g., germinal matrix.[uichildrens.org]
  • "Traumatic Brain Injury: Definition, Epidemiology, Pathophysiology" Emedicine.com. Retrieved on June 19, 2007. Vinas FC and Pilitsis J. 2006. "Penetrating Head Trauma."[en.wikipedia.org]
  • Access personal reporting Related Content This Book Next chapter Gender Differences in Incidence, Pathophysiology, and Outcome of Primary Intracerebral Hemorrhage By Michael James and Sankalp Gokhale Related Book First chapter Automatic Vector Seeded[intechopen.com]

Prevention

  • Abstract Knowledge of the timing and course of neonatal intracranial hemorrhage is essential in determining the etiology of hemorrhage, since the key to preventing neurologic damage in newborns is to define preventable causes and to treat the complications[ncbi.nlm.nih.gov]
  • These data indicate the importance of careful follow-up of survivors of intraventricular hemorrhage, early demonstration of ventricular dilation and prompt therapeutic intervention to prevent brain injury.[ncbi.nlm.nih.gov]
  • For these reasons, antenatal therapy should be a more effective preventive strategy than postnatal therapy.[nejm.org]
  • The ability to predict the occurrence of neonatal periventricular-intraventricular hemorrhage (PVH-IVH) would be useful in the design of clinical trials to prevent its occurrence.[utsouthwestern.influuent.utsystem.edu]
  • This large randomized trial tested whether phenobarbital given to a pregnant woman about to deliver a premature infant would prevent brain injuries in their newborns.[clinicaltrials.gov]

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