Tavil Betül, Korkmaz Ayşe, Bayhan Turan, Aytaç Selin, Unal Sule, Kuskonmaz Baris, Yigit Sule, Cetin Mualla, Yurdakök Murat, Gumruk Fatma
aPediatric Hematology UnitbNeonatal Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Blood Coagul Fibrinolysis. 2016 Mar;27(2):163-8. doi: 10.1097/MBC.0000000000000403.
In this study, we aimed to evaluate the incidence, risk factors, causes and clinical management of intracranial haemorrhage (ICH) diagnosed during foetal life or in the first month of life in term neonates with a discussion of the role of haematological risk factors. This study included term neonates (gestational age 37-42 weeks) with ICH diagnosed, treated and followed up in the Neonatal Intensive Care Unit of Hacettepe University, Ankara, Turkey, between January 1994 and January 2014. Medical follow-up was obtained retrospectively from hospital files and prospectively from telephonic interviews and/or clinical visits. During the study period, 16 term neonates were identified as having ICH in our hospital. In six (37.5%) neonates, ICH was diagnosed during foetal life by obstetric ultrasonography, and in 10 (62.5%) neonates, it has been diagnosed after birth. Haemorrhage types included intraventricular haemorrhage (IVH) in eight (50.0%), intraparenchymal haemorrhage in six (37.5%), subarachnoid haemorrhage in one (6.2%) and subdural haemorrhage in one (6.2%) neonate. IVH was the most common (n = 5/6, 83.3%) haemorrhage type among neonates diagnosed during foetal life. Overall, haemorrhage severity was determined as mild in three (18.7%) neonates, moderate in three (18.75%) neonates and severe in 10 (62.5%) neonates. During follow-up, one infant was diagnosed as afibrinogenemia, one diagnosed as infantile spasm, one cystic fibrosis, one orofaciodigital syndrome and the other diagnosed as Friedrich ataxia. Detailed haematological investigation and search for other underlying diseases are very important to identify the reason of ICH in term neonates. Furthermore, early diagnosis, close monitoring and prompt surgical interventions are significant factors to reduce disabilities.
在本研究中，我们旨在评估足月儿在胎儿期或出生后第一个月被诊断为颅内出血（ICH）的发生率、危险因素、病因及临床处理情况，并探讨血液学危险因素的作用。本研究纳入了1994年1月至2014年1月期间在土耳其安卡拉哈杰泰佩大学新生儿重症监护病房诊断、治疗及随访的足月儿（胎龄37 - 42周）。医疗随访通过回顾医院病历以及前瞻性的电话访谈和/或临床就诊获得。在研究期间，我院共确定16例足月儿患有ICH。其中6例（37.5%）新生儿在胎儿期通过产科超声诊断为ICH，10例（62.5%）新生儿在出生后被诊断。出血类型包括8例（50.0%）脑室周围-脑室内出血（IVH）、6例（37.5%）脑实质出血、1例（6.2%）蛛网膜下腔出血和1例（6.2%）硬膜下出血。IVH是胎儿期诊断的新生儿中最常见的出血类型（n = 5/6，83.3%）。总体而言，3例（18.7%）新生儿出血严重程度为轻度，3例（18.75%）为中度，10例（62.5%）为重度。随访期间，1例婴儿被诊断为无纤维蛋白原血症，1例诊断为婴儿痉挛症，1例诊断为囊性纤维化，1例诊断为口面指综合征，另1例诊断为弗里德里希共济失调。详细的血液学检查及寻找其他潜在疾病对于明确足月儿ICH的病因非常重要。此外，早期诊断、密切监测及及时的手术干预是减少残疾的重要因素。
