Henzi Bettina Cornelia, Wagner Bendicht, Verma Rajeev Kumar, Bigi Sandra
Division of Neuropaediatrics, University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland.
Division of Paediatric Intensive Care, University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland.
BMJ Case Rep. 2017 Dec 1;2017:bcr-2017-221144. doi: 10.1136/bcr-2017-221144.
Perinatal infratentorial haemorrhage (PIH) is a rare birth complication associated with abnormal labour.
A baby boy was born by vacuum extraction at 41 weeks' gestational age. The pregnancy was uneventful and Apgar scores were 3/6/9. Following initial resuscitation, insufficient and irregular breathing, non-reactive pupils and absence of spontaneous movements were noted. A diagnosis of perinatal asphyxia with hypoxic-ischaemic encephalopathy (HIE) was considered. Therapeutic hypothermia (TH) for 72 hours was initiated. Cerebral ultrasound showed only a mildly hyperechogenic periventricular substance. A brain MRI on the fourth day of life revealed a subdural haemorrhage in the posterior fossa with compression of the fourth ventricle.
PIH is an important differential diagnosis to HIE that can be missed with ultrasound. PIH is a treatable condition but may be aggravated by TH. Therefore, in neonates at risk for PIH, a more detailed ultrasound protocol or brain MRI should be considered early.
围生期幕下出血（PIH）是一种与异常分娩相关的罕见出生并发症。
一名男婴在孕41周时通过真空吸引分娩。孕期无异常，阿氏评分分别为3/6/9。初始复苏后，发现呼吸不足且不规律、瞳孔无反应以及无自主运动。考虑诊断为围生期窒息合并缺氧缺血性脑病（HIE）。开始进行72小时的治疗性低温（TH）。脑部超声仅显示脑室周围物质轻度回声增强。出生第四天的脑部MRI显示后颅窝硬膜下出血并压迫第四脑室。
PIH是HIE的重要鉴别诊断，超声检查可能会漏诊。PIH是一种可治疗的疾病，但TH可能会使其加重。因此，对于有PIH风险的新生儿，应尽早考虑采用更详细的超声检查方案或脑部MRI。
