新生兒顱內(nèi)出血ppt課件

1、Intracranial Hemorrhage of the NewbornEtiology and Epidemiology of ICH isoimmune thrombocytopenia neonatal vitamin K deficiency (maternal phenobarbital or phenytoin) Congenital vascular anomaly Iatrogenic hemorrhage (sucktioning, infusing, ventilating) Incidence of PVH/IVH 2040% progress during the

2、1st week Delayed hemorrhage may occur after the 1st week in 1015% of the cases New-onset IVH is rare after the 1st month of life regardless of the birthweightPathogenesis of PVH/IVH Prenatal or neonatal ischemic or reperfusion injury Necrosis of the periventricular white matter Damage to the cortico

3、-spinal fibers in the internal capsulePathogenesis of PVH/IVH Lack muscle and collagen, susceptible to rupture Vascular border zone with more mitochondria, more vulnerable to ischemia Extravascular factors No supportive stroma around the vessels Excessive fibrinolytic activityCommon Clinical Signs/S

4、ymptomsClinical Manifestation Tense and bulging of fontanel Severe neurological depression or coma Asymptomatic periods or no clinical manifestationsClinical ManifestationEarly echodense phase (310 days of life)Echolucent (cystic) phase (1420 days of life)Classification of PVH/IVH (Grading) Severe (

5、10%) Grade IV: Intraventricular hemorrhage with parenchymal hemorrhagePapile LA, J Pediatr 1978; 92:529534.DiagnosisPossible Prenatal Interventions severe PVH/IVH, controversial Optimal management of labor and delivery no consistent resultsPossible Postnatal Interventions Indomethacin CBF and fluctuations in systemic BP; closure of PDA; accelerates maturation of the germinal matrix microvasculaturePrognosis of PVH/IVH Periventricular Hemorrhagic Infraction Parenchymal hemorrh