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1、IntracranialHemorrhageoftheNewbornEtiologyandEpidemiologyofICHTrauma(epidural,subdural,orsubarachnoid)fetalheadistoolargeinproportiontothesizeofthepelvicoutletprolongedlabor/breechorprecipitatedeliveriesMechanicalassistancewithdeliveryAsphyxia/HypoxicischemicencephalopathyPrematureinfants(peri-/
2、intraventricularhemorrhage,PVH/IVH)Primaryhemorrhagicdisturbance(subarachnoidorintracerebral)DICisoimmunethrombocytopenianeonatalvitaminKdeficiency(maternalphenobarbitalorphenytoin)CongenitalvascularanomalyIatrogenichemorrhage(sucktioning,infusing,ventilating)IncidenceofPVH/IVHMostcommonneonatal
3、intracranialhemorrhageOccursprimarilyinprematureinfantsIncidenceincreaseswithdecreasingbirthweight:60~70%of500-to750-ginfants,10~20%of1000-to1500-ginfantsOccasionallyseeninnear-termandterminfantsRarelypresentatbirth50%occuronthe1stday,80~90%occurbetweenbirthandthe3rdday20~40%progressduringthe1st
4、weekDelayedhemorrhagemayoccurafterthe1stweekin10~15%ofthecasesNew-onsetIVHisrareafterthe1stmonthofliferegardlessofthebirthweightPathogenesisofPVH/IVHGelatinoussubependymalgerminalmatrix(periventricular)EmbryonalneuronsandfetalglialcellsImmaturebloodvesselsandhighlyvascularareaPoortissuevasculars
5、upportPredisposingfactorsoreventsPrematurity,RDS,Hypoxic-ischemicorhypotensiveinjury,reperfusion,increasedordecreasedCBF,pneumothorax,hypervolemia,hypertension,etcPeriventricularleukomalacia(PVL)PrenatalorneonatalischemicorreperfusioninjuryNecrosisoftheperiventricularwhitematterDamagetothecortic
6、o-spinalfibersintheinternalcapsulePathogenesisofPVH/IVHIntravascularfactorsFluctuatingcerebralbloodflow(relatedtomechanicsofventilation)IncreasinginCBF(pressure-passivecerebralcirculationinprematureinfants)IncreasesincerebralvenouspressureDecreasesinCBF(occurringprenatallyorpostnatally)Plateleta
7、ndcoagulationdisturbances(hypercoagulablestate,vitaminK)VascularfactorsImmaturevesselsinthegerminalmatrixLackmuscleandcollagen,susceptibletoruptureVascularborderzonewithmoremitochondria,morevulnerabletoischemiaExtravascularf
