Patient's question:
Neonatal intracranial hemorrhage. My baby, at 39+1 weeks, was delivered via cesarean section due to malposition. Three days after birth, we noticed that the baby was not interested in feeding and was not crying. Concerned, we took him to the neonatal department for examination, where an intracranial ultrasound revealed intracranial hemorrhage. The ultrasound findings are as follows:Brain structure: Poorly visualized, symmetrical on both sides, no obvious deviation of the midline. The midline structure is aligned with the same side.
Inner margin of the skull: 44mm: Bilateral anterior horns of the lateral ventricles are widened, left side 2.3mm, right side 1.8mm.
Bilateral choroid plexus echoes: Symmetrical, peripheries are poorly smooth.
Left and right parietal sagittal region echoes: Patchy strong echoes measuring 1810mm and 1910mm.
Left and right periventricular echoes: Patchy strong echoes measuring 167mm and 187mm.
Other findings: Transparent septum: 54mm. Multiple fluid areas were detected at the junction of the left thalamus and caudate nucleus, the largest measuring 64mm. Fluid areas were also detected at the junction of the right thalamus and caudate nucleus, measuring 43mm.
CDFI: Middle cerebral artery blood flow; VMA45.8cm/s; VMIN 19.1cm/s; PI 0.89; RI 0.58
Ultrasound findings: Patchy strong echoes in the intracranium, please correlate with clinical findings.
Fluid areas in the subependymal region on both sides, please correlate with clinical findings.
Recommendation: Re-examination.
Doctor's answer:
Generally, any factors that can cause fetal or neonatal hypoxia and ischemia during prenatal, intrapartum, and postpartum periods can lead to intracranial hemorrhage, with premature infants being more commonly affected. Due to fetal head enlargement, cephalopelvic disproportion, precipitate labor, breech presentation, high forceps delivery, or multiple vacuum-assisted deliveries, which result in compression of the fetal head, traumatic intracranial hemorrhage can also occur, more frequently in full-term infants. Premature infants, with softer skulls, may develop cerebellar hemorrhage when their heads are fixed in a supine position during the use of face masks for oxygenation, scalp vein puncture, or tracheal intubation, as this can compress the occipital bone. Additionally, a history of primary thrombocytopenic purpura in the mother or the use of anticonvulsants (phenytoin sodium, phenobarbital) or antituberculosis drugs (rifampin) during pregnancy can also cause intracranial hemorrhage in the fetus or neonate. Immature liver function and insufficient clotting factors in newborns are also reasons for bleeding.