ICH

Question 1

Caput succedaneum

Answer 1

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

Question 2

Cephalhematoma

Answer 2

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

Question 3

Intracranial Hemorrhage (ICH)

Risk factors

Answer 3

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

Question 4

ICH types

Answer 4

😭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.

Question 5

Clinical picture of ICH

Answer 5

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

Question 6

Diagnosis of ich

Answer 6

o Cranial CT scan or MRI
o Cranial ultrasonography:
o Coagulation profile (PT, PTT, platelets)
o CBC for anemia

Question 7

Management of ich

Answer 7

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