Guekos-Thöni U, Boltshauser E, Mieth D, Isler W
Helv Paediatr Acta. 1980 Dec;35(6):531-44.
In 8 singleton term infants and 1 postterm infant diagnosis of intracranial haemorrhage (ICH) was clinically established on the 2nd to the 12th day of life and subsequently confirmed by computed tomography (CT). Birth asphyxia was present in 1 infant only. 1 patient died, another developed progressing post-haemorrhagic hydrocephalus requiring a shunt. On follow-up at 2 1/2 to 30 months, psychomotor development was found to be normal in 6 children, mildly delayed in 1 and markedly delayed in another. On comparing our results of ICH in term infants to other published data on both term and preterm infants, we found that in both groups of patients ICH usually occurred within the first 7 days of life and that CT findings were often identical. Mortality rate of preterm babies with ICH was found to be 4.5 times higher than that of term babies while in surviving patients incidence of posthaemorrhagic hydrocephalus was approximately the same. Repeated lumbar punctures were shown to be therapeutically successful in some preterm infants with posthaemorrhagic hydrocephalus. We consider it worth while to use this approach in term infants, too, before placement of a shunt is considered. Etiologic factors and pathogenesis of ICH are briefly discussed at the end of the paper.
在8例足月儿和1例过期产儿中,临床上在出生后第2天至第12天确诊为颅内出血(ICH),随后经计算机断层扫描(CT)证实。仅1例婴儿存在出生窒息。1例患者死亡,另1例出现进行性出血后脑积水,需要进行分流手术。在2.5至30个月的随访中,发现6名儿童的精神运动发育正常,1名轻度延迟,另1名明显延迟。将我们关于足月儿ICH的结果与其他已发表的关于足月儿和早产儿的数据进行比较时,我们发现两组患者的ICH通常发生在出生后的前7天内,且CT表现往往相同。发现ICH早产儿的死亡率比足月儿高4.5倍,而在存活患者中,出血后脑积水的发生率大致相同。对于一些患有出血后脑积水的早产儿,反复腰椎穿刺显示治疗成功。我们认为在考虑进行分流手术之前,这种方法在足月儿中也值得一试。本文末尾简要讨论了ICH的病因和发病机制。