Intracranial Hemorrhage In Newborn Research Articles

Neonatal and obstetric risk factors are associated with the increased risk of neonatal intracranial hemorrhage

BackgroundIn newborns, intracranial hemorrhage (ICH) is an acquired lesion with a high risk of morbidity, mortality, and long-term neurodevelopmental outcomes. Despite major improvements in newborn care and greater preterm infant survival in recent decades, ICH remains a serious concern. This study aimed to determine the prevalence of ICH in newborns and the various obstetric and neonatal risk factors linked to ICH development. This case–control study was conducted throughout the period from June 2017 to December 2017.Patients and methodsThis case–control research involved 240 infants admitted to Cairo University's Obstetrics and Gynecology Hospital's Neonatal Intensive Care Unit (NICU). We took detailed history, such as the maternal, obstetric, and delivery circumstances, laying stress on maternal and obstetric ICH risk factors. The general condition was assessed at 1 and 5 min using the Apgar score. Ballard score was used to determine gestational age. The birth weight was measured. A thorough clinical examination with a focus on neurological evaluation in accordance with the Sarnat phases was performed. The authors used cranial ultrasonography for imaging (CUS).ResultsOf 240 neonates, 78 neonates developed ICH (32.5%). Overall, 42.9% were males and 21.1% were females. Intraventricular hemorrhage was the commonest one (24.2%), and grade one intraventricular hemorrhage represented 13.4%. The prevalence of asymptomatic cases with ICH was 66.7%. The neonatal risk factors associated with increased ICH risk were prematurity, representing 67.4%; pneumothorax, representing 76.9%; and trauma, representing 77.3%. The sensitivity of CUS for detection of ICH was 84.6%, and the specificity of CUS was higher, representing 97.5%. Overall, 41.03% of ICH cases appeared on the first day of life and 76.9% on the third day by CUS.ConclusionThe prevalence of asymptomatic cases with ICH was 66.7%. Certain neonatal risk factors are associated with increased risk of ICH such as birth weight, sex, gestational age, mode of delivery, and obstetric risk factors. CUS can be considered as a specific and sensitive indicator for the occurrence of ICH.

Diagnostic Value of Bedside Ultrasound in Intracranial Hemorrhage of High-Risk Neonates

To investigate diagnostic value of Bedside Ultrasound and computed tomography (CT) for detecting intracranial hemorrhage in newborn, 1750 neonates in our department of newborn intensive care unit were examined with Bedside Ultrasound and CT. After ultrasonography diagnosed 377 intracranial hemorrhage, it can be found that in premature infants the incident of intracranial hemorrhage was higher than term infants (P<0.001), and the incident of periventricle-intraventricle hemorrhage (PVH-IVH) I grade was significantly higher than grade II, III, IV (P=0.000). 41 cases grade I PVH-IVH were confirmed by Bedside Ultrasound, but negative in CT scan. It can be concluded that bedside Ultrasound have a very important clinical value to increase the incident of newborn intracranial hemorrhage, especially PVH-IVH grade I.

Pregnancy aspects related to intracranial hemorrhage in newborns of very low weight in South Brazil

To analyze the relationship between route of delivery and other aspects of pregnancy and the occurrence of intracranial hemorrhage in newborns of very low weight at a teaching hospital in South Brazil. A case-control study was conducted. Medical records of all patients who were born weighing ≤ 1,500 g and who were submitted to transfontanellar ultrasonography were analyzed from January 2011 to September 2014. The cases were newborns with diagnosis of intracranial hemorrhage, while newborns with regular exams were used as controls. Differences between groups were analyzed by the Student t test and by χ2 or Fisher exact tests, and association was determined using the odds ratio with a 95% confidence interval and α = 5%. A total of 222 newborns with birth weight ≤ 1,500 g were recorded; of these, 113 were submitted to transfontanellar ultrasonography and were included in the study. Sixty-nine (61.1%) newborns were diagnosed with intracranial hemorrhage (cases) and 44 (38.9%) showed no abnormal results (controls). Most cases had grade I hemorrhage (96.8%) originating from the germinative matrix (95.7%). The predominant route of delivery was caesarean section (81.2% of the cases and 72.7% of the controls). Five deaths were recorded (3 cases and 2 controls). Gestational age ranged from 24 to 37 weeks. Median birth weight was 1,205 g (range: 675-1,500 g). The median time of hospitalization was 52 days, ranging from 5 to 163 days. Grade I intracranial hemorrhage from the germinative matrix was the most frequent. No differences were found between cases and controls for the variables studied. The small number of infants submitted to transfontanellar ultrasonography limited the sample size and the results of the study.

Multiresolution analysis of pathological changes in cerebral venous dynamics in newborn mice with intracranial hemorrhage: adrenorelated vasorelaxation

Intracranial hemorrhage (ICH) is the major problem of modern neonatal intensive care. Abnormalities of cerebral venous blood flow (CVBF) can play a crucial role in the development of ICH in infants. The mechanisms underlying these pathological processes remain unclear; however it has been established that the activation of the adrenorelated vasorelaxation can be an important reason. Aiming to reach a better understanding of how the adrenodependent relaxation of cerebral veins contributes to the development of ICH in newborns, we study here the effects of pharmacological stimulation of adrenorelated dilation of the sagittal sinus by isoproterenol on the cerebral venous hemodynamics. Our study is performed in newborn mice at different stages of ICH using the laser speckle contrast imaging and wavelet analysis of the vascular dynamics of CVBF. We show that the dilation of the sagittal sinus with the decreased velocity of blood flow presides to the stress-induced ICH in newborn mice. These morphofunctional vascular changes are accompanied by an increased variance of the wavelet-coefficients in the areas of endothelial and non-endothelial (KATP-channels activity of vascular muscle) sympathetic components of the CVBF variability. Changes in the cerebral venous hemodynamics at the latent stage of ICH are associated with a high responsiveness of the sagittal sinus to isoproterenol quantifying by wavelet-coefficients related to a very slow region of the frequency domain. The obtained results certify that a high activation of the adrenergic-related vasodilatory responses to severe stress in newborn mice can be one of the important mechanisms underlying the development of ICH. Thus, the venous insufficiency with the decreased blood outflow from the brain associated with changes in the endothelial and the sympathetic components of CVBF-variability can be treated as prognostic criteria for the risk of ICH during the first days after birth.

WAVELET-BASED ANALYSIS OF CEREBROVASCULAR DYNAMICS IN NEWBORN RATS WITH INTRACRANIAL HEMORRHAGES

Intracranial hemorrhage (IH) is a major problem of neonatal intensive care. The incidence of IH is typically asymptomatic and cannot be effectively detected by standard diagnostic methods. The mechanisms underlying IH are unknown but there is evidence that stress-induced disorders in adrenergic regulation of cerebral venous blood flow (CVBF) are among the main reasons. Quantitative and qualitative assessment of CVBF could significantly advance understanding of the nature of IH in newborns. In this work, we analyze variations of CVBF in newborn rats with an experimental model of stress-induced IH and adrenaline injection. Our analysis is based on the Doppler optical coherence tomography (DOCT) and a proposed adaptive wavelet-based approach that provides sensitive markers of abnormal reactions of the sagittal vein to external factors. The obtained results demonstrate that the incidence of IH in newborn rats is accompanied by a suppression of CVBF with the development of venous insufficiency and areactivity to adrenaline. We introduce a numerical measure θ, quantifying reactions of CVBF and show that the values θ < 1.23 estimated in the low-frequency (LF) spectral range corresponding to the sympathicus indicate abnormal reactions associated with the development of IH. We conclude that the revealed areactivity of the cerebral veins to adrenaline represents a possible mechanism responsible for pathological changes in CVBF.

Antenatal Sonographic Diagnosis of Intraventricular Hemorrhage

The peri-intraventricular hemorrhage diagnosed antenatal is rare. The present study aims to report three cases of prenatal diagnosis of peri-intraventricular hemorrhage. Three young women were referred to our institution because of echogenic cerebral image on previous ultrasonography. There was nothing significant in their past or family history. A detailed prenatal ultrasonography revealed a ventricular echogenic image extending from the lateral ventricles to the parenchyma. No other malformation was detected. Neonatal ultrasonography confirmed the diagnosis in one case. The others died on antenatal period. Antenatal intraventricular hemorrhage. The central nervous system is the main location of congenital malformations incidence; it has high impact on mortality. The peri-intraventricular hemorrhage is the most frequent intracranial hemorrhage in newborns, especially in prematures. The hemorrhage’s origin is located in the germinal matrix. The peri-intraventricular hemorrhage diagnosed antenatal is rare. The ultrasonography is a useful method for screening and diagnosis of this condition.

Intracranial Hemorrhage in Newborns With Hemophilia: The Role of Screening Radiologic Studies in the First 7 Days of Life

In newborns with hemophilia, intracranial hemorrhage (ICH) is a potentially life-threatening event and in those who survive, there is a risk of long-term neurologic sequelae. A single-center retrospective chart review was performed to look at the utility of central nervous system screening of babies who were diagnosed with moderate or severe hemophilia in the first 7 days of life. Twenty of the twenty-two eligible babies had either a head ultrasound or computerized tomography of the head performed as soon as possible after the diagnosis of hemophilia was confirmed. ICH was found in 3 of the 20 newborns. All patients with ICH had instrument-assisted deliveries with extracranial signs of bleeding/trauma. On the basis of this series we found screening to be safe and effective in recognizing ICH. As a result of this approach, all ICHs were found when they were radiographically small and before the babies had neurologic symptoms.

Traumatic intracranial hemorrhage in newborns

Neonatal traumatic head injuries (NTHI) can be life-threatening and require aggressive treatment. The indications, techniques, and results of brain decompression are not well defined in the literature. We studied prospectively cases of NTHI with intracranial traumatic lesions; skull fractures without underlying lesions were not included. We treated 17 cases of NTHI: 7 patients had a subdural hematoma, 3 had an extradural hematoma, and the others had subarachnoid hemorrhage. Surgical evacuation of intracranial clots was performed in 7 cases, by needle aspiration in 5 and by craniotomy in 2 patients with extradural hematomas. The outcome was favorable in all but one patient, who had hemophilia A, and died of rebleeding at the age of 2 months. Surgical decompression of intracranial hematomas due to NTHI is often unnecessary; however, it may be required in emergency because of poor clinical tolerance. Whenever possible, percutaneous needle aspiration is the treatment of choice.

PEP 5354 Intracranial hemorrhage in newborns with intrauterine grouth retardation

PEP 5354 Intracranial hemorrhage in newborns with intrauterine grouth retardation

Combined antenatal vitamin K and phenobarbital therapy for preventing intracranial hemorrhage in newborns less than 34 weeks' gestation

ōk--q----_xD-xD whether maternal antenatal therapy with vitamin K and phenobarbital prevents intracranial hemorrhage in premature newborns. Women at high risk for spontaneous or indicated premature delivery before 34 weeks' gestation were randomly assigned to receive either placebo or vitamin K and phenobarbital. All patients received betamethasone and antibiotics and were managed uniformly by a single perinatal group in one hospital. All newborns were managed uniformly in the same nursery by one neonatal group. Two independent interpretations of neonatal head ultrasound examinations were obtained. The duration of gestation at study entry and at delivery were similar in the placebo (181 mothers) and treatment (191) groups. With the hospital radiology group (the primary interpreter), the incidence rates of severe intracranial hemorrhage (8 versus 7%) and mild intracranial hemorrhage (38 versus 32%) were similar for both groups. With the secondary interpreter (a single pediatric radiologist), the incidence rates of severe intracranial hemorrhage (9 versus 7%) and mild intracranial hemorrhage (27 versus 26%) were also similar. Neonatal mortality was equivalent in both the placebo and treatment groups (8 versus 10%). Combined antenatal therapy with vitamin K and phenobarbital does not reduce the frequency or severity of intracranial hemorrhage in premature newborns.

Intracranial Hemorrhage in Term or Near-term Newborns With Persistent Pulmonary Hypertension

To substantiate the clinical impression of an increased incidence of intracranial hemorrhage (ICH) in term and near-term infants with persistent pulmonary hypertension (PPH), a retrospective chart review of 35 affected patients was performed. ICH was diagnosed in 40 percent of the patients. Multiple regions of the brain were affected; in many patients, at more than one location. In addition, 43 percent of ICH victims had hemorrhages of the type associated with periventricular bleeding in preterm newborns. Of multiple obstetric and neonatal factors analyzed, many of which are identified risk factors for periventricular hemorrhage, only thrombocytopenia (p = 0.02) was significantly associated with ICH. We conclude that the risk of ICH in newborns with PPH is significant and warrants consideration by clinicians caring for this population. Risk factors (except thrombocytopenia) previously implicated in other types of neonatal ICH, particularly periventricular hemorrhage, do not significantly correlate with ICH in infants with PPH.

Maternal, fetal, and newborn complications associated with newborn intracranial hemorrhage

Two hundred twenty newborn infants with one or more fetal or newborn complications and 54 newborn infants without fetal or newborn complications were prospectively studied to assess the relationship between maternal, obstetric, fetal, and newborn complications and intracranial hemorrhage. Intracranial hemorrhage occurred in 47 newborn infants with fetal or newborn complications (21%) and in one infant with no fetal or newborn complications (2%). Maternal and obstric complications, duration of labor, and mode of delivery were not associated with intracranial hemorrhage. Newborn immaturity at delivery is an important factor in the occurrence of intracranial hemorrhage. There is little evidence that fetal hypoxia is a contributing factor. Severe respiratory complications and major infections are newborn complications associated with intracranial hemorrhage.

Role of Coagulopathy in Newborn Intracranial Hemorrhage

Fifty newborn infants of less than 33 weeks' gestation were followed prospectively from birth with serial coagulation and real-time ultrasound studies. A significant association of hypocoagulability in the first four hours of life with subsequent onset or progression of intraventricular or other clinical hemorrhages was documented. Abnormalities included lower values for fibrinogen, platelet count, antithrombin III, and factor VIII with higher values for fibrin monomer and longer Laidlaw whole blood clotting times. These abnormalities tended to correct spontaneously in surviving infants. An association between gestational complications and incidence of hypocoagulability and intracranial hemorrhage (ICH) was noted. Babies of preeclamptic mothers had fewer abnormalities and babies born to mothers with premature rupture of membranes and suspected amnionitis manifested more hypocoagulability and more severe intracranial hemorrhages.

Intracranial hemorrhage in newborn: Kelly, G. F.: Wisconsin Medical Journal, 1924, xxiii, 16

Intracranial hemorrhage in newborn: Kelly, G. F.: Wisconsin Medical Journal, 1924, xxiii, 16