Treatment of neonatal intracranial hemorrhage 1, supportive therapy
Keep children quiet, avoid moving or minimize irritating operations; Maintain normal blood pressure, ensure adequate heat supply, pay attention to fluid balance and correct acidosis.
Step 2 control convulsions
In the case of convulsion, phenobarbital or anticonvulsants, such as midazolam and cedrol, can be used.
3. Reduce intracranial pressure
Dexamethasone 0.5- 1.0mg/kg was given to patients with intracranial hypertension by intravenous drip twice a day. Mannitol can be used in cases of unequal pupils, irregular breathing rhythm, sighing and breathing or double inhalation, and the dosage depends on the condition, generally 0.25-0.5mg/kg each time, intravenous injection.
4. Hemostatic drugs
Treatment of neonatal intracranial hemorrhage can use phenylethylamine (hemostatic sensitivity), Carballo (Anluoxue), vitamin K 1 and reptilase.
5. Brain metabolic activator
After hemostasis, citicoline can be injected intravenously, 0. 1g/ time, and 50ml of 5%- 10% glucose solution can be added, once a day, 1 0-14 days as a course of treatment; 2ml cerebrolysin, diluted, intravenously, once a day, 1 0-14 days as a course of treatment. In the recovery period, Naofukang can be given 0.2g daily for 3 months.
6, brain dural puncture
Epidural puncture of brain is mainly used for subdural hemorrhage in children, once a day 1 time, and the amount of extraction per time does not exceed 15ml.
7, hydrocephalus after bleeding
For hydrocephalus after intracranial hemorrhage in newborns, ventricular puncture and drainage can be performed and taken out after 7 days. If the head circumference continues to increase, hydrocephalus shunt can be considered.
How to nurse neonatal intracranial hemorrhage? Reasonable nursing measures have a great effect on improving neonatal intracranial hemorrhage. Correct nursing is conducive to the recovery of children. Parents must not be too anxious and make nursing mistakes, which will aggravate their illness.
1, closely observe the condition: pay attention to the changes of vital signs, such as ideology, eye symptoms, portal vein tension, breathing, muscle tension, pupil changes, etc. Observe the time and place of convulsion carefully and patiently to avoid missed diagnosis. Measure the head circumference regularly, record the positive signs in time and get in touch with the doctor.
2. Maintain absolute rest: reduce noise, and all necessary treatment and nursing operations should be light, steady and accurate, so as to minimize the movement and stimulation to children. It is best to keep venipuncture for indwelling needle, reduce repeated puncture, avoid scalp puncture and prevent aggravating intracranial hemorrhage.
3. Rational use of oxygen: Give oxygen according to the degree of hypoxia, and pay attention to the way and concentration of oxygen. Stop using it in time when the condition improves.
4. Reasonable feeding: choose nasal feeding or breast feeding according to the condition to ensure the heat supply.
5. Take the medicine on time to ensure the curative effect.
6. Keep the body temperature stable: when the body temperature is too high, it should be cooled physically, and when the body temperature is too low, it should be kept warm by far-infrared radiation bed, incubator or hot water bottle. Avoid loosening the package after operation.
7. Keep the respiratory tract unobstructed and improve the respiratory function: clear the respiratory secretions in time to avoid articles pressing the chest and affecting breathing.
8. Health education: encourage adherence to treatment and follow-up. When there are sequelae, teach parents to carry out functional training for their children to enhance their self-confidence in overcoming the disease. Strengthen perinatal health care and reduce birth injuries and asphyxia caused by abnormal delivery.
Neonatal intracranial hemorrhage sequela Neonatal intracranial hemorrhage is a very common brain injury, which is caused by hypoxia or birth injury, and its prognosis is not easy to determine, which is related to perinatal factors such as etiology, quantity, location and type. Mild intracranial hemorrhage almost all survived, and the sequelae were 0- 10%. The moderate mortality rate is 5%- 15%, and the sequela is15%-25%. The mortality rate of severe illness is 50%-65%, and the sequelae are 65%- 100%.
Generally speaking, full-term infants, acute hypoxia, normal Apgar score within 20 minutes, subarachnoid hemorrhage, subependymal hemorrhage, a small amount of intraventricular hemorrhage and small frontal hematoma have better prognosis.
Premature or small for gestational age, chronic hypoxia, low Apgar score within 20 minutes, massive ventricular hemorrhage with ventricular enlargement, parietal-occipital cerebral parenchymal hemorrhage or persistent hypoglycemia have poor prognosis. Survivors often have sequelae such as epilepsy, cerebral palsy, mental retardation, visual or hearing impairment and ataxia. 10%- 15% of patients with intracranial hemorrhage in low birth weight infants have hydrocephalus, and the symptoms of intracranial hypertension are dispensable, and 65% of them may stop developing or recover.
1, mental retardation
Because intracranial hemorrhage will affect the normal development of brain cells and the intelligence of sick children. Lighter performance is that the development of sports behavior is worse than that of children of the same age, language dysfunction and poor academic performance. With proper treatment and education, they can take care of themselves and reach the level of primary school. Seriously ill children are severely mentally handicapped, and most of them can't take care of themselves and need lifelong care.
2. epilepsy
Even if children with intracranial hemorrhage survive after rescue, because a large number of intracranial hemorrhage is not cleared in time, blood clots are organized for a long time, and the organized blood clots form abnormal discharge foci in the brain, which leads to recurrent seizures in children.
3. Cerebral palsy
Due to severe intracranial hemorrhage, brain cells will be damaged to varying degrees, which will eventually affect the development of brain cells and cause cerebral palsy in children. The resulting cerebral palsy often manifests as spastic cerebral palsy. With the growth of age, parents often find it difficult to look up and sit down. The disease may be accompanied by mental retardation, and the degree of retardation is roughly parallel to the degree of paralysis.