home Acute Intraventricular hemorrhage (IVH) in newborns: causes, degrees, manifestations, prognosis. Intraventricular hemorrhage (IVH) in newborns Grade 1 IVH in newborns when appears

Intraventricular hemorrhage (IVH) in newborns: causes, degrees, manifestations, prognosis. Intraventricular hemorrhage (IVH) in newborns Grade 1 IVH in newborns when appears

Neurological pathology in newborns and children of the first years of life is a very serious problem, and, unfortunately, brain damage in babies is by no means uncommon. IVH is an intraventricular hemorrhage, which is very characteristic of the neonatal period and often accompanies the pathological course of labor.

Intraventricular hemorrhage also occurs in adults, representing one of the forms with high lethality. As a rule, blood thus enters the ventricular system from when they break through into the brain cavity.

Hemorrhage into the cerebral ventricles in children is usually isolated, not associated with parenchymal hematomas, that is, it can be considered as an independent separate disease.

intraventricular hemorrhage in a newborn

The significance of the problem of intraventricular hemorrhage in newborns is due not only to the difficulties of diagnosing and treating pathology, because many drugs are contraindicated for babies, and immature nervous tissue is extremely sensitive to any unfavorable circumstances, but also to a prognosis, which can not always reassure young parents.

In addition to children born with an abnormal course of the birth period, IVH is diagnosed in premature babies, while the shorter the gestational age at which premature birth occurred, the greater the likelihood of IVH and the more severe the degree of ischemic-hypoxic brain damage.

In babies born prematurely, half of the bleeding in the ventricles occurs already in the first day of life, up to 25% of IVH occurs on the second day after birth. The older the child, the less likely it is to have circulatory disorders in the brain, even if the birth is abnormal.

Today in the arsenal of neonatologists there are highly informative research methods that make it possible to diagnose intraventricular hemorrhage in a timely manner, but problems with the classification, determination of the stage of pathology have not yet been resolved. A unified classification of DRC has not been developed, but when formulating the stages, the features of the topography of the lesion are taken into account rather than the clinical severity and prognosis.

Causes of intraventricular hemorrhage in newborns

The reasons for the development of IVH in young children are fundamentally different from those that cause hemorrhages in adults. If in the latter, vascular factors come to the fore - hypertension, atherosclerosis, underlying strokes, and the very penetration of blood into the ventricles is secondary to intracerebral hematoma, then in newborn babies the situation is somewhat different: hemorrhage immediately occurs inside the ventricles or under their lining , and the reasons are somehow related to pregnancy and childbirth:

Prematurity condition;
Long dry period;
Severe in childbirth;
Injury with obstetric benefits (rare);
Birth weight less than 1000 g;
Congenital disorders of blood coagulation and vascular structure.

In premature babies, the presence of the so-called germinal (embryonic matrix) is considered as the main cause of intraventricular hemorrhage, which should gradually disappear as the fetal brain and vascular system matures. If childbirth occurred ahead of time, then the presence of this structure creates the prerequisites for IVH.

The germinal matrix is \u200b\u200ba region of neural tissue around the lateral ventricles that contains immature cells that travel to the brain and become neurons or neuroglia cells when they mature. In addition to cells, this matrix carries unripe capillary-type vessels, the walls of which are single-layer, therefore, they are very fragile and can rupture.

Hemorrhage into the germinal matrix is \u200b\u200bnot yet IVH, but it most often leads to the penetration of blood into the ventricles of the brain. A hematoma in the nervous tissue adjacent to the wall of the ventricle breaks through its lining, and blood rushes into the lumen. Since the appearance of even a minimal volume of blood in the ventricle of the brain, we can talk about the onset of an independent disease - intraventricular hemorrhage.

Determination of IVH stages is necessary to assess the severity of the disease in a particular patient, as well as to determine the prognosis in the future, which depend on the amount of blood that has entered the ventricles and the direction of its distribution towards the nervous tissue.

Radiologists base the determination of the IVH stage on the results of computed tomography. They distinguish:

IVH grade 1 - subependymal - blood accumulates under the lining of the ventricles of the brain, without destroying it and not getting into the ventricle. In fact, this phenomenon cannot be considered a typical IVH, but at any time, blood can break through into the ventricles.
IVH of the 2nd degree is a typical intraventricular hemorrhage without expansion of its cavity, when blood is released from the subependymal space. On ultrasound, this stage is characterized as IVH with filling less than half of the volume of the ventricle with blood.
IVH grade 3 - blood continues to flow into the ventricle, filling more than half of its volume and expanding the lumen, which can be traced on CT and ultrasound.
IVH grade 4 is the most severe, accompanied not only by filling the ventricles of the brain with blood, but also spreading it further into the nervous tissue. On CT, signs of IVH of one of the first three degrees are found along with the formation of foci of parenchymal intracerebral hemorrhage.

Based on structural changes in the brain and its cavities, three stages of IVH are distinguished:

At the first stage, the ventricles are not completely filled with blood contents, not dilated, possibly spontaneous cessation of bleeding and preservation of normal CSF dynamics.
Continuation of filling of the lateral ventricles with their possible expansion, when at least one of the ventricles is filled with blood by more than 50%, and blood spreads to the 3rd and 4th ventricles of the brain occurs at the second stage.
The third stage is accompanied by the progression of the disease, blood entering the choroid of the cerebellum, medulla oblongata and spinal cord. The likelihood of fatal complications is high.

The severity of IVH and its manifestations will depend on how quickly the blood has penetrated into the brain tissue and its cavity, as well as on its volume. Hemorrhage always spreads along the flow of cerebrospinal fluid. In severely premature babies, as well as those who have undergone deep hypoxia, disorders of the blood coagulation system occur, so clots do not appear in the brain cavities for a long time, and liquid blood “spreads” freely through the brain.

At the heart of the disturbance of the circulation of the cerebrospinal fluid and the growth in the future lies the penetration of blood into the ventricle, where it mixes with the cerebrospinal fluid, but does not immediately fold. Part of the liquid blood penetrates into other brain cavities, but as it coagulates, clots begin to overlap narrow zones through which the cerebrospinal fluid circulates. Overlapping of any of the openings of the brain entails blockage of the cerebrospinal fluid pathway, expansion of the ventricles and hydrocephalus with characteristic symptoms.

IVH manifestations in young children

Up to 90% of all hemorrhages in the ventricular system occur in the first three days of a baby's life, and the less its weight, the higher the likelihood of pathology. After the first week of a child's life, the risk of hemorrhage is significantly reduced, which is associated with the adaptation of the vascular system to new conditions and the maturation of the structures of the germ cell matrix. If the child was born prematurely, then the first days he should be under the close supervision of neonatologists - for 2-3 days the condition may worsen sharply due to the onset of IVH.

Minor subependymal hemorrhages and grade 1 IVH may be asymptomatic. If the disease does not progress, the condition of the newborn will remain stable, and neurological symptoms will not even occur. With multiple hemorrhages under the ependymus, signs of brain damage will appear closer to the year with phenomena.

Typical intracerebral hemorrhage manifests itself with symptoms such as:

Decreased muscle tone;
Flaccid tendon reflexes
Respiratory disorders up to a stop (apnea);
Seizures;
Focal neurological symptoms;
Coma.

The severity of the pathology and the features of the symptoms are associated with the volume of blood that has entered the ventricular system, and the rate of pressure increase in the cranial cavity. The minimal IVH, which does not cause obstruction of the cerebrospinal fluid and changes in the volume of the ventricles, will be accompanied by an asymptomatic course, and it can be suspected by a decrease in the number in the baby's blood.

Abrupt current observed with moderate and submassive IVH, which are characterized by:

Depression of consciousness;
Paresis or muscle weakness;
Oculomotor disorders (histagmus, strabismus);
Respiratory disorders.

Symptoms in a spasmodic course are expressed over several days, after which they gradually decrease. It is possible both a complete recovery of brain activity and minor deviations, but the prognosis is generally favorable.

Catastrophic course of IVH is associated with severe disorders of the brain and vital organs. Coma, respiratory arrest, generalized convulsions, cyanosis of the skin, bradycardia, decreased blood pressure, and impaired thermoregulation are characteristic. Intracranial hypertension is evidenced by the bulging of the large fontanelle, clearly visible in newborns.

In addition to clinical signs of impaired nervous activity, there will be changes in laboratory parameters. The occurrence of IVH in newborns may be evidenced by a drop in the hematocrit level, a decrease in calcium, fluctuations in blood sugar, often disorders of the gas composition of the blood (), electrolyte disturbances (acidosis).

To complications of IVH include the blockade of the cerebrospinal fluid by blood clots with the development of acute occlusive hydrocephalus, atrophy of the cerebral cortex and impaired psycho-motor development. Impaired circulation of cerebrospinal fluid leads to an increase in the size of the ventricles, an increase and compression of the cerebral cortex, which already suffers from hypoxia. The result is a convulsive syndrome, depression of consciousness and coma, cardiac arrest and respiratory arrest.

The progression of bleeding leads to the spread of blood from the ventricles into the cisterns of the brain and nerve tissue. Parenchymal intracerebral hematomas are accompanied by gross focal symptoms in the form of paresis and paralysis, impaired sensitivity, and generalized convulsive seizures. When IVH is combined with intracerebral hemorrhage, the risk of an unfavorable outcome is extremely high.

Among the long-term consequences of IVH, there are ischemic-hypoxic damage and residual changes in the brain in the form of periventricular leukomalacia, cortex atrophy. By about a year, a developmental delay becomes noticeable, motor skills suffer, the child cannot walk and perform correct movements with his limbs in due time, does not speak, lags behind in mental development.

Diagnosis of IVH in babies is based on an assessment of symptoms and examination data. The most informative is CT, neurosonography and ultrasound. CT is accompanied by radiation, so it is preferable for premature babies and newborns in the first days of life to have ultrasound.

IVH in a diagnostic image

Treatment and prognosis

Neurosurgeons and neonatologists are involved in the treatment of children with IVH. Conservative therapy is aimed at restoring the functioning of vital organs and blood parameters. If the child did not receive vitamin K at birth, then it must be administered. The deficiency of clotting factors and platelets is replenished by transfusion of plasma components. When breathing stops, artificial ventilation of the lungs is carried out, but it is better to establish it as planned, if there is a risk of respiratory disorders.

Drug therapy includes:

Normalization of blood pressure to prevent a sharp decrease or surges that aggravate hypoxia and damage to the nervous tissue;
Oxygen therapy;
Anticonvulsants;
Blood clotting control.

To reduce intracranial pressure, the introduction of magnesium sulfate is shown intravenously or intramuscularly, diacarb, furosemide, veroshpiron are used for term infants. Anticonvulsant therapy consists in the appointment of diazepam, valproic acid preparations. To relieve the symptoms of intoxication, infusion therapy is performed, acidosis (acidification of the blood) is eliminated by using an intravenous sodium bicarbonate solution.

In addition to medication, surgical treatment of IVH is carried out: evacuation of blood from the ventricles of the brain through their puncture under the control of ultrasound, the introduction of fibrinolytic agents into the lumen of the ventricles (actelize) to prevent thrombosis and occlusive hydrocephalus. Perhaps a combination of puncture with the introduction of fibrinolytic drugs.

In order to remove the products of tissue decay and eliminate the symptoms of intoxication, CSF filtration, CSF sorption and intraventricular lavage with artificial cerebrospinal fluid preparations are shown.

With blockage of the cerebrospinal fluid and hydrocephalic syndrome, temporary drainage of the ventricles is established with the evacuation of blood and clots until the cerebrospinal fluid is cleared and the obstruction of its outflow pathways is eliminated. In some cases, repeated lumbar and ventricular punctures, external ventricular drainage, or temporary internal drainage with implantation of artificial drainage under the skin are used.

ventricular drainage catheter insertion

If hydrocephalus has acquired a persistent and irreversible character, and the effect of fibrinolytic therapy is absent, then neurosurgeons provide permanent drainageoperatively:

Installation of permanent shunts with outflow of cerebrospinal fluid into the abdominal cavity (a silicone tube passes under the skin from the head to the abdominal cavity, the shunt can be removed only if the child's condition is stabilized and hydrocephalus does not progress);
Endoscopic anastomoses between the ventricles of the brain and the basal cistern.

The most common method of surgical treatment of occlusive hydrocephalus against the background of IVH is considered ventriculoperitoneal drainage... It is affordable, allows for the injection of drugs into the ventricles, has a low probability of infection, can be carried out for a long time, while caring for a child is not accompanied by difficulties. The use of alteplase, which accelerates the dissolution of blood clots in the ventricles, allows reducing mortality and maximizing the functioning of the brain.

Forecast in IVH, it is determined by the stage of the disease, the volume of hemorrhage and the localization of damage to the brain tissue. At the first two degrees of IVH, the blood clots are absorbed either by themselves or under the action of treatment, without causing significant neurological disorders, therefore, with small hemorrhages, the child can develop normally.

Massive intraventricular hemorrhages, especially if they are accompanied by damage to the brain tissue, can lead to the death of the infant in a short time, and if the patient survives, then it is problematic to avoid neurological deficits and gross disorders of psychomotor development.

All children with intracranial hemorrhages are subject to close observation in intensive care and timely surgical treatment. After installing a permanent shunt, the disability group is determined, and the baby should be regularly shown to a neurologist.

In order to avoid the described severe changes, it is important to observe the measures for preventing brain damage in newborns and very premature infants. Expectant mothers need to undergo the necessary preventive examinations and examinations in a timely manner, and in case of the threat of premature birth, the task of obstetricians-gynecologists is to prolong the pregnancy as much as possible with medications until such time as the risk of hemorrhage becomes minimal.

The birth of a child is a rather unpredictable process and often as a result, the baby's health suffers. Of particular danger to the health of the baby are brain damage resulting from and. Oxygen starvation of the brain can lead to the development of IVH in newborns - intraventricular hemorrhage. The risk of such a complication lies in wait mainly for children who were born prematurely. This is due to the immaturity of the vessels and the structural features of the brain in this group of newborns. Premature babies have a special structure in their brains - the germinal matrix, the cells of which later create the skeleton of the brain, migrating to the cortex. Intraventricular hemorrhage in newborns occurs as a result of rupture of the vessels of the germinal matrix and the flow of blood into the lateral ventricles. Due to IVH, the migration of cells of the germinal matrix occurs with impairments, which adversely affects the development of the child, causing his delay.

IVH degrees

IVH of 1 degree - hemorrhage is limited to the wall of the ventricles, not spreading to their cavity.
IVH of the 2nd degree - hemorrhage enters the ventricular cavity.
IVH grade 3 - there are violations in the circulation of cerebrospinal fluid causing hydrocephalus.
IVH grade 4 - hemorrhage extends to the brain tissue.

IVH of 1 and 2 degrees of severity in newborns are usually characterized by an asymptomatic course, and they can only be detected with the help of examination by additional methods (computed tomography, neurosonography).

Consequences of DRC

The consequences of IVH for the health of the newborn depends on many factors, in particular on the severity of hemorrhage, the gestational age of the baby, the presence of developmental pathology and concomitant diseases. IVHs of 1 and 2 degrees in newborns in 90% of cases dissolve without a trace, without causing serious harm to the health of the child. IVHs 3 and 4 degrees cause motor disorders and neuropsychological problems.

Intraventricular hemorrhage (IVH) is a pathology in which small blood vessels burst and bleed into the ventricles of the brain of a newborn child.

The ventricles are cavities in the brain that are filled with CSF (cerebrospinal fluid). A person has several of them and they all connect with each other.

The diagnosis of IVH is often made in premature babies, due to their physiological characteristics. The shorter the gestational age, the higher the likelihood of hemorrhage.

Hemorrhages do not appear just like that, there must be reasons for this violation.

Who is at risk?

Hemorrhage in the brain of newborn children can be associated with both damage to the skull itself, and with a lack of oxygen.

Prerequisites for DRC:

Overweight or, conversely, undermaturity... Premature babies are especially susceptible to intracranial hemorrhages, since their immature vessels do not yet have sufficient support in the tissues. In late-born babies, the bones become hardened and the head is unable to configure itself during childbirth. IVH, according to statistics, occurs in every fifth premature and every tenth post-term baby.
The size of the fetal head does not match the size of the birth canal... In this case, natural delivery is contraindicated, because it is fraught with injuries and hypoxia for the newborn child.
Difficult pregnancy (fetal hypoxia, intrauterine infection with various infections).
Difficult (protracted or rapid) labor, breech presentation.
Wrong actions of obstetricians during childbirth.

Based on the above, several risk groups can be distinguished.

The risk of cerebral hemorrhage in a child increases with:

prematurity;
low birth weight (less than 1.5 kg);
oxygen deficiency (hypoxia);
head injury during childbirth;
difficulty breathing during childbirth;
infections leading to blood clotting disorders.

If the child belongs to at least one of these groups, it is necessary to find out if he has symptoms of intracranial hemorrhage.

Typical symptoms

There are not always visible signs of hemorrhage. Also, if a child has any of the symptoms below, then it is not at all necessary that this is due to IVH, they can be caused by other diseases.

The most common symptoms of intraventricular hemorrhage in infants are:

In premature infants, IVHs are manifested by a sharp and rapid deterioration in the condition on the second or third day after birth.

Severity

There are several classifications of hemorrhages, most of them include 4 stages. Below is the grading used most often in modern medicine:

It is possible to establish one or another degree of hemorrhage only with the help of a special study.

Diagnostic methods and criteria

For diagnosis in the presence of appropriate symptoms, as a rule, it is used (with the help of sound waves, ruptures of blood vessels and bleeding are determined). Also, blood tests for anemia, metabolic acidosis, infections are taken.

When diagnosing a pathology of any degree, a specialist selects an individual treatment for the patient.

Possibilities of modern medicine

If a child has a hemorrhage in the ventricles of the brain, then he should be under the vigilant supervision of the medical staff. The baby is monitored to make sure it is stable.

Basically, therapy for IVH is aimed at eliminating complications and consequences. If any diseases arise as a result of hemorrhage, appropriate treatment is prescribed.

Sometimes (if too much fluid accumulates in the brain), the following measures are taken:

Ventricular (through the fontanelle) or (through the lower back) punctures.
when a special drainage tube is inserted into the ventricles. It extends under the skin to the patient's abdomen, where excess CSF is absorbed. The drainage system must be in the body at all times, and the tube must be replaced if necessary.

It should be noted that for most patients (with 1 and 2 degrees of IVH), any therapy is not required at all; a favorable outcome can be expected.

Caution, video of the operation! Click to open

Prognosis depending on the degree of hemorrhage

The consequences will depend on the degree of IVH and the adequacy of the actions of the medical staff:

Preventive measures

It is impossible to prevent one hundred percent of a cerebral hemorrhage in an infant, but some measures can and should be taken to reduce the risk.

Correct definition of tactics of delivery

Often, perinatal intracranial hemorrhages occur due to birth trauma, so it is extremely important to carefully assess the ratio of the woman's pelvis to the fetal head.

If there is a discrepancy, natural childbirth is contraindicated, a cesarean section is prescribed. This operation is also performed for diseases associated with a decrease in platelets in the blood of a pregnant woman or fetus (poor clotting).

In addition, in this case, special therapy is prescribed (corticosteroids, immunoglobulin, platelet mass). During childbirth, it is important to monitor the blood pressure of the baby, it is necessary to avoid fluctuations so that cerebral blood flow does not increase.

Prenatal screening

Although these studies are not mandatory for a pregnant woman, they should not be ignored.

In addition, you should be aware that intracranial hemorrhages are possible not only in newborns. They can occur due to trauma at absolutely any age.

01.05.2010, 07:21

Hello.
Please help to cure the child.
Data of an extract from the RD:

Pregnancy: 2nd birth, 2nd pregnancy, at 39-40 weeks, ACS, light water, "boiled" placenta. Pregnancy of 1.2 half - no features. Apgar score 8-9 points, boy 4070 g, 56 cm, env. Goal. 35 cm, env. breasts. 37 cm.
The child's condition in the following days: satisfies. at birth, worsening by the end of 1 day to moderate severity due to the syndrome of vegetative-visceral disturbances, regurgitation s-ma (after each feeding in the volume of the eaten mixture).
Applied to the breast on the 5th day, the umbilical cord residue disappeared on the 4th day, jaundice: no.
MUMT on the 6th day: 354 gr., 8.6% Mass at discharge: 3716 (maximum weight loss) The mother refused to continue her stay in the RD.
Survey conducted:
NSH on the 2nd day of a child's life: In the projection of the caudate nuclei, a hematoma 1.4-0.5 cm is located on the left supependimally. Hematoma of a heterogeneous structure due to small pseudocysts, the stage of lysis, intrauterine hemorrhage is not excluded. IVH of 1 degree, on the left.
Radiography of the CS: signs of trauma in the CS at the C3 level (C3 dislocation posteriorly within 1.0 mm)
Examination by a surgeon on the second day of life: EGDS - acute erymatous reflux esophagitis, acute erosive hemorrhagic gastritis.
Neurologist: Cerebral ischemia of hypoxic genesis, with vegetative-visceral disorders, with regurgitation, IVH of 1 degree on the left.
Treatment: c. Shantsa, Infusion therapy according to indications up to 6 days. according to physiological needs.
Audiological screening on the 5th day: blood pressure - normal, AC - no. Re-screening at 1 month is recommended.
Clinical analysis: Cerebral ischemia of the 2nd degree of hypoxic genesis, IVH of the 1st degree, see vegetative-visceral disorders, with regurgitation, about. erythematous reflux esophagitis, about. erosive and hemorrhagic gastritis. Gr. risk by IUI.
Health group: 3
Risk factors: 16 p.

Examination by a pediatrician on the 7th day:
Breastfeeding, on demand, lactation is sufficient. Wakefulness is calm, sleep is calm, with a total duration of up to 20 hours per day, the physique is correct, the muscle tone is dystonic, decreased in the arms (more in the proximal parts of the arms) more than in the legs.
Reflexes of the newborn: proboscis +, searching +, sucking +, grasping +, support: no 2 phases p. Robinson, the areas of the legs quickly fade away, crawling +, automatic gait +.
Visual analyzer: 7 days, auditory analyzer: 7 days.
The skin is physiological, the turgor is reduced, the subcutaneous tissue is developed moderately, evenly. Musculoskeletal system: no visible defects, with-m short neck (underlined by the pediatrician with a wavy line), "doll's handle"
The fontanelle: 2.0x2.0 at the level of bony formations, the bones of the skull are dense.

Examination by a neurologist on the 25th day:
Complaints about changes in NSH, chin tremor
Ob.no: about the goal. 38 cm, br 3.0x3.0, not tense. General cerebral s-we: regurgitation of the medical device - the glance fixes, ptosis nista ... no. Smoothness of the right nasolabial fold. There are no bulbar disorders. Hearing impaired on the left? Muscle strength is not reduced. Muscular dystonia with increased tone in the folds of the arms, adductor thigh muscles (more on the right). S-m of the doll's head, lying on its stomach, does not lean well on the right handle. When verticalizing, support on the upper edge of the feet, draws the toes, step reflex with crossing the legs at the level of the feet. The reflexes of the newborn are vivid. D-z: post-hypoxic-ischemic post-hemorrhagic perinatal encephalopathy, hydrocephalic s-m, neuromuscular dystonia syndrome, vegetative-visceral disorders.
Recommended:
1. EFZ with 1% solution of aminophylline on SHOP according to Rabner 10
2.gliatilin 1.0 i / m N12
3. Actovegin 0.5 / m No. 10
4.glycine 0.1 x 1/2 tab. under the tongue 1 month
5. Repeat NSG after treatment
6. Examination by a neurologist, pediatrician

Examination by a pediatrician at 1 month: height 56.5, weight 5170 (+1100 in 1 month) Okr goal 38.5 (+3.5 cm), chest 40 (+3.0), BR 2.0x2.0
Functional state: no complaints, state of satisfaction Satisfied nutrition, the skin is clean, on the cheeks and behind the ears. Muscle tone is satisfactory; Head throws back from time to time. Reflexes of newborns: grasping, Babkin's, Robinson's vivid symmetric, Moro phase 1, support on tucked toes, stepping, protective, Bauer, Gallant, Perez - see ... VI VPR.
Conclusion: FR macrosomia, disharm. due to env. breast, NPR 1 gr.
Dz: PEP, ChChS, s-m NMD, vegetative-visceral dysfunctions. HELL, infant var-t, lok. f-ma, early. p-d

Parents comment: a child of 1.5 months, regurgitation, then disappears altogether, but now they have become more frequent, they occur almost after each feeding (0.5 teaspoon-3 tablespoons) with both milk and curdled and watery. The stool is normally yellow without mucus. Rarely with green blotches. The stomach is puffed up. The child is calm, sleeps all night, feeds 2-3 times at night. During the day, the period of wakefulness increases to 4-6 hours. Spits up more often when pushing. The child groans, rarely cries. Distinguishes the mother's voice, perks up at the sight of the breast, turns his head from side to side behind the toy, smiles when addressing him.
The smile is sometimes asymmetrical, the mouth is slightly crooked.
In the prone position, holds the head for 15-20 seconds. The child bends while crying, if worn vertically throws his head back.

Questions:
1. DRC 1 degree - what threatens in the future? What are the projections given the history and pregnancy.
2. Should I use the drugs prescribed by the neurologist?
3. After three procedures of electrophoresis, a mastic rash appeared (in the area of \u200b\u200binsertion of electrodes), the treatment was stopped. The rash goes away, but slowly (already a week). Is it worth continuing the EFZ?
Thank!

01.05.2010, 10:56

Such intrauterine hemorrhage does not need any treatment. A hematoma of similar size is independently lysed (resolved) with the formation of a small cyst.
You cannot influence this process with medication, especially with those drugs that the neurologist prescribed. This treatment is unnecessary. Moreover, in addition to being useless, it can also be harmful to the child.
Electrophoresis is also not shown. Only developmental activities are needed. Children are quite plastic, and in the vast majority of cases such problems disappear relatively without a trace.

01.05.2010, 11:40

Thank you very much for your reply. But local doctors, on the contrary, say that the worst thing is the formation of a cyst, and in order to prevent this, such drugs are prescribed.
Please advise what to look for in the future, so as not to miss the moment and start treating the child (if necessary).
Is it an alarming symptom that the child sometimes falls asleep with his eyes open, i.e. first sleeps with open eyes, and then plunges into a deep sleep and closes?
And more ... Will massage, gymnastics provoke any negative phenomena, tk. the neurologist categorically forbade nat. procedures, since this, according to her, will provoke negative dynamics.

01.05.2010, 12:34

Such cysts are the result of hematoma lysis. This is a natural, normal recovery process. Nature has come up with such a mechanism, there is absolutely nothing terrible in it. I repeat once again - it is IMPOSSIBLE to influence him with these drugs.
Neither massage nor gymnastics can provoke negative phenomena and negative dynamics.
And in general, after such statements, I would run away from this neurologist until the child is treated with something even more extravagant.

22.07.2010, 16:57

Firstly, thank you very much, dear doctors, for saving my child from a bunch of pointless injections.: Ax :: ax :: ax: Indeed, according to the results of the NSG by the end of the second month, only a pseudocyst with a diameter of 1.5 mm was found.
Everything resolved without actovegin and gliatilin. Did one massage course and that's it.

Secondly, there is a question about the current state of the child.

The child is 4 months old. Grabs toys with both hands, brings his hands in front of him, babbles actively, from 3.5 months. turns over on its stomach, distinguishes between relatives. Worried about what the child has recently begun to do.

The brain has a very complex structure. In addition to gray and white matter, the brain contains structures filled with a special fluid called cerebrospinal fluid. The internal structures of the brain filled with cerebrospinal fluid are called cerebral ventricles, there are only four of them: two lateral, third and fourth. CSF is formed in the ventricles of the brain, flows through them, then enters the intrathecal spaces of the brain and spinal cord and is absorbed there into the circulatory system.

Due to the immaturity of the entire brain, premature babies are at risk of rupture of fragile cerebral vessels and the development of hemorrhage in the brain, and most often this hemorrhage occurs in the ventricles of the brain.

Intraventricular hemorrhage (IVH) - This is a hemorrhage in the ventricles of the brain.

The lower the gestational age of the child, the higher the frequency of IVH. The incidence of IVH is especially high in children born before 28 weeks of gestation. Typically, IVHs develop within the first 3 days after a baby is born.

IVH is diagnosed using ultrasound of the brain (neurosonography - NSH). There are three degrees of IVH.

IVH of 1 degree - This is a small hemorrhage. If the child's condition has stabilized and the progression of hemorrhage is not observed, then IVH of the 1st degree becomes harmless; it already, as a rule, does not lead to complications and does not require treatment. A child with grade 1 IVH undergoes neurosonography several times to make sure the hemorrhage does not progress and then goes into resolution. IVH of the 1st degree does not have an adverse effect on the development of the child.

IVH 2 and, especially, 3 degrees - these are already more significant hemorrhages, which can affect both the child's condition and lead to complications. With IVH of the 2nd degree, there is an outpouring of blood into the ventricle, with IVH of the 3rd degree, there is still hemorrhage into the brain substance surrounding the ventricle (periventricular region). The development of IVH of 2 and 3 degrees can worsen the general condition of the child, worsen breathing, lead to apnea (respiratory arrest) and impaired cardiac function. It is also possible to develop seizures. Treatment is based on all developing symptoms.

With massive outpouring of blood into the ventricles of the brain, the risk of the main complication increases - occlusive hydrocephalus... Unfortunately, there are currently no remedies that can prevent this complication.

Occlusive hydrocephalus (dropsy of the brain) is characterized by a progressive expansion of the ventricles of the brain as a result of impaired outflow of cerebrospinal fluid. Blockage of the CSF outflow tract occurs due to the proliferation of certain cells in the walls of the ventricles under the irritating influence of blood and its decay products. Thus, the cerebrospinal fluid continues to form in the ventricles of the brain, but since the outflow pathways are blocked, the cerebrospinal fluid accumulates more and more in the ventricles, leading to their progressive expansion and an increase in intracranial pressure. In such cases, neurosurgical assistance is required. At the beginning, ventricular punctures (punctures of the ventricle of the brain) can be performed in order to remove excess cerebrospinal fluid, temporary drainages (tubes for draining the cerebrospinal fluid) can also be installed into the cerebral ventricle. When the child's condition allows, then the main stage of neurosurgical treatment is carried out, which should ensure a constant drainage of cerebrospinal fluid from the ventricles.

The prognosis for the development of a child with IVH of 2 and 3 degrees is determined by the degree of damage to the brain substance and the presence of occlusive hydrocephalus. With IVH of grade 2 without hydrocephalus, the likelihood of the subsequent favorable development of the child is high. With IVH of grade 3, as well as if occlusive hydrocephalus develops, the risk of impaired psychomotor development of the child, the formation of cerebral palsy, and epilepsy increases.

Kryuchko Daria Sergeevna

Head of the Division for Analysis and Coordination of Work to Improve the Delivery of Neonatological Care

Federal State Budgetary Institution "Scientific Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of the Ministry of Health of the Russian Federation,

Director of the Directorate of Social Projects of the Foundation for Social and Cultural Initiatives.

Scientific editor of the journal “Neonatology. News, opinions, training ”.

Doctor of Medical Sciences.