The birth of children is a rather unforeseen process, and often as a result of this, the state of health of the child suffers. Brain defects resulting from asphyxia and hypoxia during the baby's waiting period are a particular threat to the well-being of the child. Such a pathology can serve as a reason for the appearance in newly born IVH (intraventricular hemorrhage). The threat of such a complication awaits mainly a child who appears premature. The reason is the immaturity of blood vessels and the distinctive features of the structure of the brain in the presented category of newborns.
Such babies have a special structure in the brain called the germinal matrix, the cells of which subsequently form the brain frame, 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 migration occurs with violations, which negatively affects the development of the baby, initiating its delays. But also, overriding pregnancy is no less dangerous. More on this later.
Because of this, this disease affects mainly only premature babies
Premature babies have the specific 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 simply can be injured. An important place is the complication of decreasing 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 ruled out. It happens both congenital and transient, in other words, temporary (as a rule, due to the influence of certain medications). However, IVH does not occur in all babies born prematurely. For the most part, this also happens when the mother carried the child. This factor negatively affects the health of the baby. And therefore, you need to ensure that there is no overshoot of pregnancy.
Specific conditions have been identified that contribute to the appearance of IVH in children. Most of them are listed 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).
- Increased blood pressure, which increases cerebral hemorrhage.
- Changes in the saturation of the blood flow of the brain.
- Difficulties of the blood coagulation system.
- Infectious and other inflammatory processes in mothers before childbirth or in children after them.
- Rendered with defects or untimely initial resuscitation assistance.
- Regular attacks of respiratory arrest and respiratory pathology, which are characteristic of premature and long-term infants.
- The introduction into the vein of electrolytes, the concentration of elements in which exceeds their permissible 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.
Grades of high fatty acids
There are four levels of disease severity. It is worth familiarizing yourself with each of them in more detail:
- First-grade IVH in newborns - hemorrhage is trimmed by the wall of the ventricles without spreading to their deepening.
- High-grade fatty acids of the 2nd degree - enters the deepening of the ventricles.
- High-grade fatty acids of the 3rd degree - pathologies in the circulation of cerebrospinal fluid, initiating hydrocephalus.
- IVH grade 4 - hemorrhage spreads to the brain tissue.
High-fatty acids of the first and second severity levels in newborns differ, as a rule, in an asymptomatic course, and it is possible to identify them only by examination with additional methods.
Diagnostics
Medical diagnosis of brain defects, in particular in thoroughly premature babies, is very difficult. This is due to the complete immaturity of organs and tissues, poor health due to somatic pathology, as well as examination problems in the couveuse and when staying on mechanical ventilation. Moms who have a baby are advised to consult a doctor on their own for an examination. After all, the problem can not be seen in the initial stages with the naked eye. Diagnose pathology with the help of the following methods.
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, financial accessibility, the absence of the need for sedation and radiation exposure, the likelihood of repeated intravesical studies. Transdermal NSH is considered the main method for diagnosing IVH in newborns. Moreover, recognition through a large fontanel is mainly focused on assessing the state of supratentorial structures, including side and ventricles. More informative recognition - frontal, at the level of Monroe 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 fontanel 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
The diagnosis of VL in infants is made on the basis of an anamnesis, a general clinical picture, information from an interdigital ultrasound or CT scan, determination of risk conditions, interrelated with weight when born.
Subdural hemorrhages in transferred babies whose head volume does not meet 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 of the forehead, protrusion of a large fontanelle, convulsive seizures and anemia . The late manifestation often leads to thoughts of abusive behavior with the newborn.
Subarachnoid hemorrhages often give rise to short-term convulsions amid a relatively mild condition. Although intensive intraventricular hemorrhages quickly give colorful clinical manifestations in premature infants: shock, marble-cyanotic skin color, anemia, coma, swelling of the large fontanel, numerous signs are absent or are not considered characteristic.
Repeated ultrasound of the brain in newborns makes it possible to recognize the formation of later atrophy of the cerebral cortex, porencephaly; talk about the severity, increase or decrease of posthemorrhagic hydrocephalus. Diffuse-weighted MRI greatly facilitated early diagnosis and is often prescribed for severe cases.
Observation and treatment of children with IVH
Taking into account the fact that intraventricular hemorrhages are considered to be the lot of premature babies, their monitoring is performed in the intensive care unit of newborns, and then in the nursing department of small babies who were born prematurely. Compliance with the correct regime in the department is very significant. Doctors and nurses tend to confine most of the manipulations to a constant time so as not to disturb the children too much. After all, even measuring the weight of deeply premature outside the walls of the incubator is considered to be a huge stress for them and can cause IVH. The clinic staff is very careful about premature babies.
It should be borne in mind that in addition to this pathology, the baby has many other concomitant problems: immaturity of the lungs and breathing problems, respiratory rate in newborns is disturbed, cardiovascular pathologies, difficulties with assimilation of the mixture or mother's milk, frequent layering of the infection 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 infants, it is important to observe the circumference of the head. When it in its size grows by more than 10 millimeters per week, it is necessary from time to time to control the volumes of the ventricles by the method of NSG. As for the direct treatment of IVH, it largely depends on the level of hemorrhage and its complications. The same applies to a long-born, large child, with suspicion of such a problem.
Spinal puncture
Certain specialists use this method of treatment for incessant ventriculomegaly, to "release" the ventricles. There is evidence of the ineffectiveness of this kind of therapy.
They also prescribe medications that reduce intracranial pressure, have decongestant and diuretic effects. These substances can only help combat the associated difficulties with ventriculomegaly, but they 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 capacity for cerebrospinal fluid, which is implanted under the skin. This makes it possible to "throw off" excess cerebrospinal fluid from the ventricles. This cure is short-term.
Permanent shunt
This procedure for IVH in newborns is performed, as a rule, when the baby grows and gets stronger. The shunt is introduced in the following way: one end passes into the ventricle, the other goes into the abdominal cavity of children (most often), and excess cerebrospinal fluid will leave here. In many cases, complications of the operation occur, for example, clogging a shunt or attaching an infection.
What are the forecasts?
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 concomitant pathologies. It is worth saying that nevertheless there is some statistical information about the consequences. Severe neurological differences (convulsions, infantile cerebral palsy, oligophrenia) appear in 7% of cases after an IHI of the first degree, in 17% of cases - after the second degree. Every third preschooler suffers from serious neurological difficulties after IV grade III, and 93% of children after the last stage. Of course, less severe neurological results after intraventricular hemorrhages are quite common.