新生儿颅内出血(Intracranial-Hemorrhage-of-the-Newborn)VIP专享VIP免费

IntracranialHemorrhageoftheNewborn(ICH)Contentsmastered:ThemaincausesofneonatalICHThemechanismofPVH-IVHClassificationandmanifestationofPVH-IVHDiagnosisofneonatalICHPreventionofneonatalICHAseverediseaseinneonateRelatedtoperinatalasphyxiaandtrauma,andmaturityoffetusTherearefourmajortypesSubduralhemorrhagePrimarysubarachnoidhemorrhageIntracerebellarhemorrhagePeriventricular-intraventricularhemorrhage(PVH-IVH)IntroductionEtiologyandEpidemiologyofICHTrauma(epidural,subdural,orsubarachnoid)Trauma(epidural,subdural,orsubarachnoid)•fetalheadistoolargecomparedwiththesizeofthepelvicofetalheadistoolargecomparedwiththesizeofthepelvicoutletutlet•prolongedlabor/breechorprecipitantdeliveriesprolongedlabor/breechorprecipitantdeliveries•DeliverywithmechanicalassistanceDeliverywithmechanicalassistanceAsphyxia/Hypoxic-ischemicencephalopathyAsphyxia/Hypoxic-ischemicencephalopathyMaturityofneonate:germinalmatrix,PVH/IVHPVH/IVHforfor20-3020-30%infantswithBW<1500g%infantswithBW<1500gPrimaryhemorrhagicdisturbancePrimaryhemorrhagicdisturbance(subarachnoidorintr(subarachnoidorintracerebral)acerebral)•DICDIC•isoimmunethrombocytopeniaisoimmunethrombocytopenia•neonatalvitaminKdeficiency(maternalphenobarbitalorpneonatalvitaminKdeficiency(maternalphenobarbitalorphenytoin)henytoin)CongenitalvascularanormalityCongenitalvascularanormalityIatrogenichemorrhage(sucktioning,infusing,ventilIatrogenichemorrhage(sucktioning,infusing,ventilating)ating)PVH/IVHMostcommonneonatalintracranialhemorrhageMostcommonneonatalintracranialhemorrhageOccursprimarilyinprematureinfantsOccursprimarilyinprematureinfants•Incidenceisinverselyproportionalwithbirthweight:Incidenceisinverselyproportionalwithbirthweight:60~70%of500-to750-ginfants,10~20%of1000-to1500-ginfants60~70%of500-to750-ginfants,10~20%of1000-to1500-ginfantsOccasionallyseeninnear-termandterminfantsOccasionallyseeninnear-termandterminfantsRarelypresentatbirthRarelypresentatbirth•50%onthe150%onthe1ststday,80~90%betweenbirthandthe3day,80~90%betweenbirthandthe3rdrddayday•20~40%progressduringthe120~40%progressduringthe1ststweekweek•Delayedhemorrhageafterthe1Delayedhemorrhageafterthe1ststweekin10~15%ofthecasesweekin10~15%ofthecases•New-onsetIVHisrareafterthe1New-onsetIVHisrareafterthe1ststmonthofliferegardlessofthebirthmonthofliferegardlessofthebirthweightweightPathogenesisofPVH/IVHGelatinoussubependymalgerminalmatrixGelatinoussubependymalgerminalmatrixatperiventricularareaatperiventriculararea•EmbryonalneuronsandfetalglialcellsEmbryonalneuronsandfetalglialcells•Immaturebloodvesselsofgerminalmatrix:thinwallsforesselsofgerminalmatrix:thinwallsfortheirrelativelylargesize,lackofamuscularislayertheirrelativelylargesize,lackofamuscularislayer•Poorextravascularsupport:Poorextravascularsupport:immatureinterendothelialimmatureinterendothelialjunctionsjunctionsPredictivefactorsoreventsPredictivefactorsorevents•Prematurity,RDS,Hypoxic-ischemicorhypotensiveinjury,Prematurity,RDS,Hypoxic-ischemicorhypotensiveinjury,reperfusion,increasedordecreasedCBF,pneumothorax,hreperfusion,increasedordecreasedCBF,pneumothorax,hypervolemia,hypertension,etcypervolemia,hypertension,etcPathogenesisofPVH/IVHIntravascularfactorsIntravascularfactors•Fluctuatingcerebralbloodflow,occurringprenatallyorpostnatally(relFluctuatingcerebralbloodflow,o...