Trauma intracranial

Injury intracranial birth is a brain damage of the child during childbirth, which is based on the rupture of blood vessels and intracranial hemorrhage.

Etiology and pathogenesis. Small hemorrhages can arise as a result of diapedesis of erythrocytes, factors that contribute to the onset of intracranial birth trauma are the pathology of pregnancy (toxicosis, eclampsia, mother's diseases), excessive mechanical compression of the fetal head during passage through the birth canal (narrow pelvis, fetal position abnormalities) . The predisposing factors are morphological incompleteness and variants, the structure of the vessels and the vascular wall, reduced resistance of capillaries, low prothrombin and fibrinogen content in the blood of newborns and possible defects of the blood coagulation system, imperfection of the nervous regulation of vascular tone. Severe oxygen deficiency and acidosis also predispose to the occurrence of hemorrhages due to increased vascular permeability, the development of brain hypoxia. Depending on the location, epidural hemorrhages (intracranial cephalematomas) are distinguished - if the bones of the skull are damaged; Subdural - in the defeat of venous sinuses, rupture of cerebellar nematodes; Subarachnoid - into the soft medulla and sub-abdominal space; Intraventricular - in the lateral, rarely in III and IV ventricles, in the substance of the brain, are found mainly in premature infants.

The clinical picture is determined by the localization and size of the hemorrhage. Extensive hemorrhages in the area of ​​vital centers are immediately apparent to the ambassador of birth by an extremely difficult condition. Symptoms of intracranial injury may appear later, after a few hours and even a day. In the clinic of intracranial birth trauma, 3 stages of neurovascular disorders are distinguished. Stage I - general depression: a decrease in muscle tone, lack of active movements, a weak expression of physiological reflexes (proboscis, Moro, Robinson, Babinsky, etc.). Characteristic nystagmus, strabismus, a symptom of the setting sun. Skin pale, with a cyanotic shade; Respiratory distress; Bradycardia, arrhythmia. Stage II - excitation: there is a general excitement, disordered movements, hypertension of the muscles, tremor, clonic convulsions; Tension of the big fontanel. Cyanosis of the extremities, skin around the mouth; Increased respiratory disorders, tachycardia is noted. There are paresis and paralysis. Stage III - slow recovery of CNS functions; Can be delayed. The child lags behind in the neuro-psychic and physical development. With spinal puncture (carried out with caution), increase the pressure of the liquid to 100-160 mm of water. Art. (In the norm of 70-90 mm Hg), in the cerebrospinal fluid - cytosis (50 cells or more), altered erythrocytes, protein up to 2 g / l and more.

The diagnosis is based on the data of anamnesis, clinic, examination of the fundus, cerebrospinal fluid, EEG, echoencephalography.

Differential diagnosis is carried out with malformations of the brain, encephalopathies, perinatal infections, metabolic disorders (hypocalcemia, hypoglycemia.

Treatment. Complete rest, ice-to-head bubble, moistened oxygen, aminazine at a dose of 2 mg / (kg-day) in / m, diuretic-lasix; Mannitope and sorbitol inside by 0.5 g / (kg-day); In / in plasma or gemodez, neokompensan 10 ml / kg, 10-15 ml of 20% glucose solution. To excite the respiratory center, ethizol is injected with 0.3-0.5 ml of 1.5% solution in / m or 2-3 times a day or cordiamine. Assign phenobarbital inside with cramps to 0,005-0,01 g 2 times a day, 25% solution of magnesium sulfate to 0.2 mg / kg IM. To enhance blood clotting, vitamin K is prescribed at 5-10 mg per day, 10% calcium chloride solution one teaspoon 4-5 times a day, ascorbic acid 100-150 mg, rutin.

The prognosis is always serious because of high mortality or the development of persistent disability.

Prevention: antenatal fetal protection, prevention of asphyxia, treatment of toxicoses.