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1、新生儿颅内出血(Intracranial-Hemorrhage-of-the-Newborn)AseverediseaseinneonateRelatedtoperinatalasphyxiaandtrauma,andmaturityoffetusTherearefourmajortypesSubduralhemorrhagePrimarysubarachnoidhemorrhageIntracerebellarhemorrhagePeriventricular-intraventricularhem
2、orrhage(PVH-IVH)IntroductionEtiologyandEpidemiologyofICHTrauma(epidural,subdural,orsubarachnoid)fetalheadistoolargecomparedwiththesizeofthepelvicoutletprolongedlabor/breechorprecipitantdeliveriesDeliverywithmechanicalassistanceAsphyxia/Hypoxic-ischemice
3、ncephalopathyMaturityofneonate:germinalmatrix,PVH/IVHfor20-30%infantswithBW<1500gPrimaryhemorrhagicdisturbance(subarachnoidorintracerebral)DICisoimmunethrombocytopenianeonatalvitaminKdeficiency(maternalphenobarbitalorphenytoin)Congenitalvascularanormali
4、tyIatrogenichemorrhage(sucktioning,infusing,ventilating)PVH/IVHMostcommonneonatalintracranialhemorrhageOccursprimarilyinprematureinfantsIncidenceisinverselyproportionalwithbirthweight:60~70%of500-to750-ginfants,10~20%of1000-to1500-ginfantsOccasionallyse
5、eninnear-termandterminfantsRarelypresentatbirth50%onthe1stday,80~90%betweenbirthandthe3rdday20~40%progressduringthe1stweekDelayedhemorrhageafterthe1stweekin10~15%ofthecasesNew-onsetIVHisrareafterthe1stmonthofliferegardlessofthebirthweightPathogenesisofP
6、VH/IVHGelatinoussubependymalgerminalmatrixatperiventricularareaEmbryonalneuronsandfetalglialcellsImmaturebloodvesselsofgerminalmatrix:thinwallsfortheirrelativelylargesize,lackofamuscularislayerPoorextravascularsupport:immatureinterendothelialjunctionsPr
7、edictivefactorsoreventsPrematurity,RDS,Hypoxic-ischemicorhypotensiveinjury,reperfusion,increasedordecreasedCBF,pneumothorax,hypervolemia,hypertension,etcPathogenesisofPVH/IVHIntravascularfactorsFluctuatingcerebralbloodflow,occurringprenatallyorpostnatal
8、ly(relatedtopressure-passivecerebralcirculation,mechanicalventilation,sucktion,infusion)Increasingofcerebralvenouspressure(mechanicalventilation,rapidinfusionorinfusionofhyperosmoticliquid)Plateletandcoagulationdisturbances(hyper
