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1、IntracranialHemorrhageoftheNewborn (ICH)Contentsmastered:ThemaincausesofneonatalICHThemechanismofPVH-IVHClassificationandmanifestationofPVH-IVHDiagnosisofneonatalICHPreventionofneonatalICHAseverediseaseinneonateRelatedtoperinatalasphyxiaandtrauma,andmaturityoffetusTherearefourmajortypesSubdura
2、lhemorrhagePrimarysubarachnoidhemorrhageIntracerebellarhemorrhagePeriventricular-intraventricularhemorrhage(PVH-IVH)IntroductionEtiologyandEpidemiologyofICHTrauma(epidural,subdural,orsubarachnoid)fetalheadistoolargecomparedwiththesizeofthepelvicoutletprolongedlabor/breechorprecipitantdeliverie
3、sDeliverywithmechanicalassistanceAsphyxia/Hypoxic-ischemicencephalopathyMaturityofneonate:germinalmatrix,PVH/IVHfor20-30%infantswithBW<1500gPrimaryhemorrhagicdisturbance(subarachnoidorintracerebral)DICisoimmunethrombocytopenianeonatalvitaminKdeficiency(maternalphenobarbitalorphenytoin)Congenit
4、alvascularanormalityIatrogenichemorrhage(sucktioning,infusing,ventilating)PVH/IVHMostcommonneonatalintracranialhemorrhageOccursprimarilyinprematureinfantsIncidenceisinverselyproportionalwithbirthweight:60~70%of500-to750-ginfants,10~20%of1000-to1500-ginfantsOccasionallyseeninnear-termandterminf
5、antsRarelypresentatbirth50%onthe1stday,80~90%betweenbirthandthe3rdday20~40%progressduringthe1stweekDelayedhemorrhageafterthe1stweekin10~15%ofthecasesNew-onsetIVHisrareafterthe1stmonthofliferegardlessofthebirthweightPathogenesisofPVH/IVHGelatinoussubependymalgerminalmatrixatperiventricularareaE
6、mbryonalneuronsandfetalglialcellsImmaturebloodvesselsofgerminalmatrix:thinwallsfortheirrelativelylargesize,lackofamuscularislayerPoorextravascularsupport:immatureinterendothelialjunctionsPredictivefactorsoreventsPrematurity,RDS,Hypoxic-ischemicorhypotensiveinjury,reperfusion,increasedordecreas
7、edCBF,pneumothorax,hypervolemia,hypertension,etcPathogenesisofPVH/IVHIntravascularfactorsFluctuatingcerebralbloodflow,occurringprenatallyorpostnatally(relatedtopressure-passivecerebralcirculation,mechanicalventilation,sucktion,infusion)
