1. Intracranial Hemorrhage of the newborn (ICH)

2. purpose To be familiar with etiology, pathogenesis and prognosis
To master clinical manifestation
To master diagnosis and treatment

3. Introduction
The intracranial hemorrhage (ICH) is one of the most common and dangerous disease with very high mortality & disability rate in alive cases.
The morbidity of ICH:
premature infants > term infants

4. Introduction
There are different etiology and varying prognosis. With improvement in perinatal care, survival percentage of ICH has considerable improvement recently.

5. Etiology & Pathology Premature Ischemic and hypoxia Birth trauma
Others

6. Clinical manifestation
Symptoms are relevant to the amount of hemorrhage and hemorrhage position.
Mild ICH may have no symptoms, severe case may die.

7. Clinical manifestation
Common symptoms and signs:
Conscious disturbance
Increased intracranial pressure
Breathing disorder

8. Clinical manifestation
Abnormal eye signs
Muscular tension
Primary reflex
Jaundice and anemia without reasons

9. Clinical manifestation
According to hemorrhage position,
ICH be divided into 5 types
Periventricular-intraventricular hemorrhage (PVH-IVH)
Primary subarachnoid hemorrhage (SAH)
Intraparenchymal hemorrhage (IPH)
Subdural hemorrhage (SDH)
Cerebellar hemorrhage (CH)

10. Clinical manifestation
Periventricular-intraventricular hemorrhage (PVH-IVH):
1. Preterm infants (GA<32weeks, VLBW) are high risk baby.
2. Incidence in preterm infant: 40-50%
Incidence in term infant: 2-3%
3. Occurrence of hemorrhage :
50% within 24hr
90% within 72hr.

11. Clinical manifestation
PVH-IVH: according to ultrasound and CT scan, PVH-IVH be divided into 4 degrees
Ⅰ: Subependymal hemorrhage
Ⅱ: Intraventricular hemorrhage without enlarged cerebral ventricular
Ⅲ: Intraventricular hemorrhage with enlarged cerebral ventricular
Ⅳ : Intraventricular hemorrhage with intraparenchymal hemorrhage

12. PVH-IVH Ⅰ Ⅱ Ⅲ Ⅳ

13. Subependymal hemorrhage
ultrasound
Subependymal hemorrhage

14. ultrasound
Intraventricular hemorrhage without enlarged cerebral ventricular

15. ultrasound
Intraventricular hemorrhage with enlarged cerebral ventricular

16. ultrasound
Intraventricular hemorrhage with intraparenchymal hemorrhage

17. Clinical manifestation
Primary subarachnoid hemorrhage (SAH)
Very common, especially in preterm infants.
Position: subarachnoid space
Reason: relevant with hypoxia, acidosis and birth trauma. Blood effusion from capillary of subarachnoid space, no damage of vein, the amount of hemorrhage is small.
Typical manifestation: convulsion at 2ndday, normal between convulsion.
Majority no symptoms, prognosis is good. Rarely die

18. Clinical manifestation
Intraparenchymal hemorrhage (IPH)
Veinlet thromb is the most common reason
Symptoms are different for different position and amount of hemorrhage
If hemorrhage of brain stem occurs, neonate presents change of pupils, irregular respiration, bradycardia
Poor prognosis

19. Clinical manifestation
Subdural hemorrhage（SDH）
Most common ICH caused by birth trauma
Most of neonates with SDH are macrosomia of term
Incidence decrease with improved technology of obstetrics
Onset early: <24h.
Symptoms: convulsion, hemiparalysis, anorthopia, etc.
severe cases may die.

20. Clinical manifestation
Cerebellar hemorrhage (CH)
Most cases are premature infants (GA < 32 weeks, VLBW)
Severe case presents symptoms of brain stem
Poor prognosis

21. Diagnosis History Symptoms & signs
Radiological evidence: the basis of diagnosis.

22. Treatment General treatment: Keep quiet
Maintain PaO2, PaCO2 and pH normal

23. Treatment
Hemostasis
vitamin K1
Reptilase (Hemocoagulase
Dicynone

24. Treatment
Control seizure
Phenobarbital
Diazepam
10%Chloral hydrate

25. Treatment
Decreasing intracranial pressure
Furosemide
20%Mannitol

26. Treatment Treatment of hydrocephalus
acetazolamide: decrease produce of cerebrospinal fluid.

27. Prognosis
Related to the severity of bleeding and locations. High mortality and instabilities.

28. Prevention Prenatal care Prevention of asphyxia & birth injury
Improve level of doctor and nurse.