Intracranial Hemorrhage - Treatment
When treatment is required for an infant with an intracranial hemorrhage, time is of the essence. Preventing permanent injury and impairment is a priority, and saving the infant’s life is even more so. It’s often not known what kinds of physical, cognitive, or emotional impairments may be present during recovery and over the next few years of development.
Get A 100% Free CASE EvaluationSometimes, the treatment consists of just observing the patient’s condition. Small bleeds can resolve on their own, but often evasive measures are taken. One option is hypothermia therapy, which involves cooling the baby down for at least three days. It is especially used for infants with hypoxic ischemic encephalopathy. Defined by general neurological abnormalities, this condition is characterized by reduced consciousness, seizures, depression of reflexes, and breathing difficulties.
If blood gas analysis of the umbilical cord indicates hypoxia or asphyxia, there is a high risk of conditions such as cerebral palsy, ischemic encephalopathy, and other problems. Inducing brain hypothermia can improve chances of survival and has reduced the occurrence of disability in babies who experience intracranial bleeding and the associated effects. Specifically, cooling the brain helps to preserve nerve cells that have a reduced supply of blood and oxygen.
Hypothermia and Cell Preservation
By reducing body temperature to around 33 degrees Celsius, it is possible to prevent the cerebral metabolism from being disrupted. The use of oxygen and glucose goes down, and high energy phosphates aren’t lost as quickly either. This can reduce the risk of processes of brain damage such as cerebral energy failure and delayed cerebral lactic alkalosis. The procedure can also prevent a loss of cerebral cortical activity that is associated with energy failure.
Hypothermia can also reduce the infiltration of blood from a hemorrhage into the brain tissues, thereby reducing the effects of trauma. With mild hypothermia, it is possible to reduce the rate of coagulation, as the release of platelet activating factor is inhibited. The biological effects of this cooling can reduce how many cells die off, which can limit the amount of brain damage and its effects on the child.
Intracranial Pressure Monitoring
A pressure monitor is inserted into the skull if physician’s suspect hydrocephalus. Not only can doctors measure intracranial pressure, but also use the device to drain cerebrospinal fluid. Depending on the equipment, measurements of temperature and brain oxygen tension are possible. The infant is typically sedated, so they remain calm and motionless, which also helps to manage elevated pressure inside the head.
Blood Pressure Management
Hematomas often grow if the person has severe hypertension. That means more blood can pool up in the brain, but medications to lower blood pressure can possibly reduce the growth of the hemorrhage. Otherwise, it may grow and compress the brain tissue surrounding it.
Anti-Seizure Medication
Medications are often administered to control seizures and convulsions. If the infant’s level of consciousness is decreased, and there is no apparent reason why doctors may also continuously monitor brain activity as well. Seizures are a major concern with intracranial bleeding.
Blood Transfusions
The loss of blood can quickly lead to anemia. A red blood cell transfusion can quickly restore the supply of oxygen and other key nutrients to the brain. Anemia can severely affect the prognosis of the patient. Resolving it with a transfusion can prevent mortality, although the outcome of a patient with a large hematoma is often more uncertain and not as favorable.
Prevention
To prevent intracranial hemorrhage, proper obstetric care is important. During a high-risk pregnancy, bacterial infections should be treated, and physicians should take measures to prevent premature labor. Cesarean section delivery can reduce the risks of head trauma. If an infant is born pre-term, proper ventilation and other therapies, such as hemodynamic control, can prevent a hemorrhage or help stop one from progressing.
If there’s any suspicion of a problem, medical treatments to prevent metabolic acidosis, organ damage, and a lack of oxygen should be administered. One should also look out for dehydration, sepsis, blood clotting, or a vitamin K deficiency to treat such issues promptly. The goal is to prevent the situation from getting worse, reduce the need for surgery, and avoid permanent injury to vital cells and structures in the brain.