ICH Flashcards
Caput succedaneum
Subcutaneous fluid collection Seen immediate after birth Criteria
o Diffuse scalp swelling (cross the suture lines) o Over the presenting part of the head o Soft consistency o May be with ecchymosis of the overlying skin
Treatment: Nothing required; it resolves in few days
Cephalhematoma
Sub-periosteal blood collection seen few hours after birth
o Localized scalp swelling (never cross sutures lines )
o Over any bone (commonly parietal or occipital)
o Firm consistency
o Possible associations:
- Linear fracture in 15-20%
- Anemia and jaundice (if large)
Treatment
-Observe ; most cephalhemaomas resolves spontaneously over 8 weeks y Treat complications - Blood transfusion for anemia
- Phototherapy for jaundice
- Antibiotics, Incision and drainage for infection y Avoid diagnostic aspiration➡️carries risk of infection
Intracranial Hemorrhage (ICH)
Risk factors
1-Macrosomia: This is a pregnancy condition in which the fetus is larger than average for the gestational age.
2-Cephalopelvic disproportion (CPD): This pregnancy condition occurs when the fetus is too large to fit through the mother’s pelvis easily.
3-Abnormal fetal presentation, such as a fetus in the breech, face, or brow presentation
4-Trauma from prolonged labor and using instruments
5-Abnormal changes in blood pressure
6- Blood disorders, such as vitamin K deficiency or hemophilia
7-Hypoxic-ischemic encephalopathy
ICH types
😭Subdural hemorrhage
😭Subarachnoid hemorrhage
😭 Germinal matrix hemorrhage / intraventricular hemorrhage (GMH/IVH):
- Mainly in preterm; mainly in the first 3 days of life
- Starts in the highly vascular periventricular germinal matrix then may extend to the ventricular system.
Clinical picture of ICH
y Asymptomatic: Common; basically with GMH / IVH
y Mild hemorrhage
- Reduced spontaneous movements
- Hypotonia , poor suckling and Moro
- Apneas
- Anemia and fall of hematocrit
- Abnormal eye movements
y Severe hemorrhage - Bulging fontanels
- Decerebrate posturing
- Hypotension, Collapse
- Hypoxia
- Seizures
Diagnosis of ich
o Cranial CT scan or MRI
o Cranial ultrasonography:
o Coagulation profile (PT, PTT, platelets)
o CBC for anemia
Management of ich
Prevention of IVH y A single course of antenatal steroids for 24-34 wk pregnancies of gestation
that are at risk for preterm delivery y Low-dose indomethacin (0.1 mg/kg/day for 3 days) to VLBW preterm
infants reduces the incidence of severe IVH y Avoid fluctuation in cerebral blood flow by regulating blood pressure and
PaCO2 y Reduce infants fighting the ventilator by using synchronized ventilation
and minimal handling and minimal ETT suctioning y Correct any coagulopathy
😁Treatment
y Supportive care in NICU
y Treat anemia with blood transfusion
y Correct any coagulopathy
y Consider starting inotropes e.g. Dopamine if hypotension persists
y Symptomatic treatment for e.g. seizures, raised intracranial tension
y Repeat cranial ultrasound at intervals (usually within 3-5 days then weekly)
y Neuro Surgical consultation