Brain hemorrhage in a newborn

Pregnancy and childbirth are not easy for women. But in their hardships they are not alone: the prenatal period and the subsequent birth for the baby are considered no less difficult.

Unfortunately, not always everything goes smoothly, and certain dangerous complications are possible. One of these complications of pregnancy and childbirth is a cerebral hemorrhage in a newborn. What it is and why it happens, we will tell you in this material.

About pathology

Cerebral hemorrhage belongs to the category of the most severe birth injuries, which usually have an unfavorable course and prognosis. It occurs due to a violation of the integrity of the blood vessels, as a result of which blood begins to accumulate under the membranes of the brain, in the interhemispheric space, sometimes the whole brain tissue is saturated with it.

Naturally, the functions of the brain are impaired, the activity of the central nervous system undergoes changes, often lethal or irreversible. It is cerebral hemorrhage that is considered the most common cause of neonatal death in babies, as well as the development of cerebral palsy in survivors.

Of course, a lot depends on which vessel, in which area of the brain is damaged, how much blood has accumulated, what are the changes in the brain tissue and membranes due to the pressure of the blood mass and leaching, but in general, the forecasts are still, alas, considered unfavorable.

Depending on the exact location of the hemorrhage, several types of pathology are distinguished:

epidural - the accumulation of blood is observed between the cranium and the gray medulla, the brain tissue is not affected;
subdural - an accumulation of blood is present between the soft and hard meninges;
subarachnoid - bleeding is localized between the membrane and the gray matter;
interventricularf - blood accumulates in the space between the ventricles of the brain and in them;
parenchymal (intracerebral) - blood accumulates in the medulla itself, permeates it.

It should be noted that all these types are considered dangerous, but parenchymal and epidural bleeding is commonly called the most severe.

They are rather difficult to establish, and therefore, at the time of diagnosis, the pathology may already have the scale of a global catastrophe.

There are three degrees of pathology, according to the WHO recommendation. Russian doctors use a four-stage classification.

1 degree corresponds to a hemorrhage affecting only the walls of the ventricles of the brain, not their cavity.
2 degrees corresponds to the pathology with the penetration of blood into the ventricles of the brain.
When 3 degrees blood spreads outside the ventricles and fills the lateral ventricles
When 4 degrees there is a massive hemorrhage with damage to the ventricles, lateral ventricles and medulla.

The size of the hemorrhage also matters.

If the area of the lesion is not more than a centimeter, they speak of a mild form of pathology, with an increase in the area of hemorrhage up to one and a half centimeters, they put a medium-severe form, if the area of the lesion exceeds one and a half centimeters, we will talk about pathology in a severe form.

Causes

Cerebral hemorrhage can develop for a variety of reasons associated with the development of a child in the womb, or with the actions of doctors and some complications during childbirth.

Quite often, cerebral hemorrhage occurs in deeply premature babies who were born before 32 weeks of pregnancy. Their brain is immature, weak, it is not able to withstand changes in pressure during childbirth, the integrity of the vessels is violated already due to the premature birth of the baby.

Neurosurgeons note that the percentage of the likelihood of a cerebral hemorrhage in a premature baby weighing more than one and a half kilograms is about 50%. In babies, whose birth weight is less than a kilogram, a stroke of one degree or another is observed in 100% of cases.

Other reasons include the following.

Acute hypoxia during childbirth. Sharp oxygen starvation can develop with abrupt, rapid childbirth, as well as with prolonged childbirth with a long stay of the baby in an anhydrous period (after the amniotic fluid has passed). The non-traumatic nature of the hemorrhage in this case somewhat increases the chances of a more favorable outcome for life.
Midwife actions. The imposition of forceps, improper extraction of the fetal head can lead to a fracture of the skull bones, and then traumatic hemorrhage develops.
Postterm pregnancy. If childbirth occurs after 42 weeks, the likelihood of the baby getting a cranial injury during childbirth increases, because the bones of the skull at this time begin to lose the elasticity necessary for unhindered passage through the birth canal. Birth trauma to the skull can be the main cause of subsequent cerebral bleeding.
Unfavorable pregnancy. Acute hemorrhage in the brain during gestation usually leads to abortion, fetal death. After birth, pathology may develop due to some malformations of blood vessels, heart, brain. Also, the cause can be intrauterine infection of the fetus with dangerous viruses and bacteria.

If a woman belongs to a risk group (the woman's age is over 40, pregnancy was accompanied by gestosis, severe toxicosis, bears a large fetus with a narrow pelvis, etc.), the woman is usually offered to reduce the risk of hemorrhage in the child by surgical delivery.

After a cesarean section, brain disorders, circulatory disorders in babies develop infrequently.

Symptoms and Signs

A child who has a slight hemorrhage at birth will not immediately let know about it. Perhaps at birth he will be more lethargic, perhaps he will cry later, but after a few hours the symptoms will appear, and doctors will be able to diagnose the pathology.

Symptoms of cerebral hemorrhage are manifested, acutely, suddenly. The baby's condition deteriorates sharply. It is difficult to say what the specific signs will be, it all depends on the size and location of the hematoma inside the skull.

Most often, convulsions appear, vomiting opens, the child loses consciousness. Strabismus may appear sharply (the pupils begin to "look" towards the affected hemisphere). Many babies have trouble breathing, it becomes intermittent, and then it may stop.

Usually in the maternity hospital they manage to provide first aid and provide the child with a ventilator.

A constant cry may indicate subarachnoid hemorrhage, low pressure and squint - epidural bleeding.

Experienced neonatologists have many signs by which they can distinguish not only pathology, but also suggest its size and localization. However, without an accurate diagnosis, a conclusion cannot be made.

To confirm hemorrhage, the baby is urgently performed neurosonography and computed tomography of the brain.

Treatment

The child should be treated as soon as the diagnosis is confirmed. Resuscitation assistance is provided if necessary. Therapy is aimed primarily at normalizing blood circulation in the brain, at reducing intracranial pressure. If the hematoma is large, and the child's condition is serious, he may undergo an emergency neurosurgical operation.

If the child's life can be saved, parents are warned about a long recovery period without any guarantees, because the consequences of cerebral hemorrhage can be very diverse.

During the recovery process, which can last for several months, or several years, and sometimes for the whole life, the child will be shown dispensary observation by a neurologist, whose recommendations parents will have to strictly follow.

Predictions and consequences

The infant brain is unique in its own way.

He has high adaptability and compensation abilities. And that is why, in most cases, it is possible to cope with light cerebral hemorrhages, if they are properly treated. But even with them, the child's rehabilitation process will take a long time.

If the degree of hemorrhage was higher than the second, and the course is severe, then the probability of the child's disability in the future is high. The degree of damage to the functions of the brain will depend on how destructive the hematoma turned out to be for him. Common lesions in such cases are infantile cerebral palsy, epilepsy, hydrocephalus, and dementia.

In the case of severe hemorrhage of the parenchymal type, the survival rate of children is extremely low. Almost one hundred percent death is recorded in the case of hemorrhage with a ruptured sickle or cerebellar tentorium.

Reviews

According to mothers' reviews, the main thing is not to lose self-control when a pediatrician in a maternity hospital reports a baby's brain hemorrhage. Hemorrhages occur more often than we used to think, and not every child will have to become disabled because of this.

Mothers willingly share their stories and emphasize that long-term treatment and recovery period have done their job - in most cases, children grow up quite normal, go to kindergartens, go to school with grades, and do not complain about anything.

Severe forms of hemorrhage in a child is a reason for contacting a psychologist. Believe me, every maternity hospital has a psychologist to work with pregnant women and women in labor. It will help you believe in the best, tune in to the baby's wave.

Experienced neonatologists say that children whose mothers are crying and nervous are worse at getting out of a difficult state than children whose mothers are internally gathering and aiming for the best. Children feel supported even when they are unconscious in intensive care.