The birth of children is a rather unforeseen process, and often as a result of this the child's he alth suffers. Brain defects resulting from asphyxia and hypoxia during the period of expectation of the baby have a particular threat to the well-being of the child. Such a pathology can cause IVH (intraventricular hemorrhage) in newly born babies. The threat of such a complication awaits mainly a child who appeared prematurely. The reason is the immaturity of the vessels and the distinctive features of the structure of the brain in the presented category of newborns.
These babies have a special structure in the brain called the germinal matrix, the cells of which subsequently form the framework of the brain, migrating to the cortex. Intraventricular hemorrhage in newborns appears due to rupture of the vessels of the matrix, and blood entering the lateral ventricles. Due to IVH, cell migrationoccurs with violations, which negatively affects the development of the baby, initiating his delays. But also, prolongation of pregnancy is no less dangerous. More on that later.
Because of what this disease mainly affects only premature babies
Premature babies have specific features of the structure of the lateral ventricles and periventricular spheres: the arteries in them are in a germinal state and have a simple structure. These arteries are called the subependymal germinal matrix. They are very fragile and can easily be injured. An important place is the complication of the decrease in venous blood from these areas, the pathology of the constancy of the internal environment of the body. The impact of concomitant disorders in the blood coagulation system is not excluded. It can be both congenital and transient, in other words, temporary (usually due to the influence of certain medications). However, IVH does not occur in all premature babies. For the most part, this also happens when the mother was carrying the baby. This factor negatively affects the he alth of the baby. And therefore, you need to make sure that there is no overpregnancy.
Identified specific conditions that contribute to the appearance of IVH in children. Most of them are named below:
- The birth of a thoroughly premature baby.
- Critically formed moments of hypoxia (lack of air to body tissues).
- High pressure in the venous bed (either during childbirth or during synthetic lung ventilation).
- Increase in blood pressure, which increases brain bleeding.
- Changes in brain blood flow saturation.
- Difficulties in the blood coagulation system.
- Infectious and other inflammatory processes in the mother before childbirth or in children after them.
- Provided with defects or untimely initial resuscitation.
- Regular bouts of respiratory arrest and respiratory pathologies that are common in premature and post-term babies.
- Injection into the vein of electrolytes, the concentration of elements in which exceeds their allowable values (this is called hyperosmolarity).
As you can see, there are many causes of IVH in newborns. The task of parents is to eliminate them as much as possible.
Degrees of IVH
There are four levels of disease severity. It is worth familiarizing yourself with each of them in more detail:
- IVH of the 1st degree in newborns - hemorrhage is cut off by the wall of the ventricles, not spreading into their recess.
- IVH of the 2nd degree - falls into the deepening of the ventricles.
- IVH of the 3rd degree - pathologies in the circulation of the cerebrospinal fluid, initiating hydrocephalus.
- IVH of the 4th degree - hemorrhage spreads to the brain tissue.
IVH of the first and second levels of severity in newborns are usually asymptomatic, and they can be detected only when examined by additional methods.
Diagnosis
Medical diagnosis of brain defects, particularly in severely preterm infants, is very difficult. This is due to the complete immaturity of organs and tissues, poor he alth due to somatic pathology, as well as problems of examination in the incubator and while on artificial lung ventilation. Mothers who have carried a child are advised to contact the doctor for an examination on their own. After all, the problem can not be seen in the initial stages with the naked eye. Pathology is diagnosed with the assistance of the methods listed below.
Neurosonography
The main value in the early diagnosis of IVH and other intracranial defects belongs to neuroimaging. The obvious advantages of NSG are safety, speed, non-invasiveness, reliability, affordability, no need for sedation and radiation exposure, and the likelihood of repeated intra-cup studies. Transfontanellar NSG is considered the main method for diagnosing IVH in newborns. At the same time, recognition through the large fontanelle is mainly focused on assessing the state of the supratentorial structures, including the collateral and ventricles. More informative recognition is frontal, at the level of Monro's holes; and parasagittal, at the level of the thalamocaudal notch. In order to better visualize the structures of the posterior cranial fossa, additional study through the mastoid fontanelle is necessary. With NSH, hyperechoic zones are formed in the matrix area, blood clots in the ventricles and ventriculomegaly can be detected.
Ultrasound and CT
VH is diagnosed in babies on the basis of anamnesis, generalclinical presentation, information from transfontanellar ultrasound or CT, identification of risk conditions associated with birth weight.
Subdural hemorrhages in post-term babies whose head size does not match the parameters of the mother's pelvis are often diagnosed belatedly, at the age of approximately one month, if the gradual accumulation of subdural exudate leads to an increase in head circumference, overhanging forehead, protrusion of a large fontanel, convulsive seizures and anemia. Late onset is often suggestive of neonatal abuse.
Subarachnoid hemorrhages often cause short-term convulsions in a relatively mild condition. Although in preterm infants, intense intraventricular hemorrhages quickly give colorful clinical manifestations: shock, cyanotic marbled skin, anemia, coma, bulging of the large fontanelle, numerous signs are absent or are not considered characteristic.
Repeated ultrasound of the brain in newborns makes it possible to recognize later atrophy of the cerebral cortex, porencephaly; talk about the severity, increase or reduction of posthemorrhagic hydrocephalus. Diffusion-weighted MRI has greatly facilitated early diagnosis and is often used in severe cases.
Monitoring and treatment of children with IVH
Given that intraventricular hemorrhages are considered the lot of premature babies, their monitoring is performed in the neonatal intensive care unit, and then in the nursing departmentsmall children who were born prematurely. It is very important to maintain the correct regimen in the department. Doctors and nurses tend to time most of the manipulations to a constant time so as not to disturb the children unnecessarily. After all, even measuring the weight of very premature babies outside the walls of the incubator is considered to be a huge stress for them and can cause IVH. The clinic staff takes care of premature babies very carefully.
It should be taken into account that in addition to this pathology, the baby has many other associated problems: lung immaturity and breathing problems, respiratory rate in newborns is disturbed, cardiovascular pathologies, difficulties in digesting formula or mother's milk, often layering of the infectious process, etc. For this reason, signs of hemorrhage are mixed with symptoms of other problems. This will require painstaking monitoring of premature babies, taking a significant number of tests and performing additional methods of study.
Baby head circumference
In premature babies, it is important to observe the circumference of the head. When it grows in its size by more than 10 millimeters per week, it is necessary from time to time to control the volume of the ventricles using the NSG method. As for the direct treatment of IVH, it largely depends on the level of hemorrhage and its complications. The same applies to a post-term, large baby, with a suspicion of such a problem.
Spinal taps
Specific Specialistsuse this method of treatment with incessant ventriculomegaly, to "release" the ventricles. There is evidence of the ineffectiveness of this type of therapy.
They also practice the purpose of medications that reduce intracranial pressure, have decongestant and diuretic effects. These substances can only help to deal with the associated difficulties in ventriculomegaly, but do not cure it.
External Ventricular Drainage
During the procedure for IVH in newborns, a shunt (tube) is inserted that connects the ventricle and the CSF container, which is implanted under the skin. This makes it possible to "throw off" excess cerebrospinal fluid from the ventricles. This measure of cure is short-term.
Permanent shunt
This procedure for IVH in newborns is usually performed when the baby grows and gets stronger. The shunt is inserted in the following way: one end passes into the ventricle, the other goes into the abdominal cavity of children (most often), excess cerebrospinal fluid will drain here. In many cases, complications of the operation occur, such as blockage of the shunt or infection.
What are the predictions?
It is difficult to determine all the consequences of IVH for a child, since the numerous difficulties of thoroughly premature babies are explained by other comorbidities. It is worth saying that there are still certain statistical data on the consequences. Severe neurological differences (convulsions, cerebral palsy, oligophrenia) appear in 7% of cases after IVH of the first degree, in 17% of cases- after the second degree. Every third preschooler suffers from serious neurological difficulties already after III degree IVH, and 93% of children after the last stage. Of course, less severe neurological outcomes after intraventricular hemorrhages are very common.
