Hill A, Volpe J J
Ann Neurol. 1981 Aug;10(2):109-21. doi: 10.1002/ana.410100202.
The review deals with neonatal seizures, perinatal hypoxic-ischemic brain injury, and neonatal intraventricular hemorrhage. neonatal seizures are the most prominent signals of the largest number of neonatal neurological disorders. The convulsive phenomena may be subtle. The predominant etiological process is hypoxic-ischemic encephalopathy. Prognosis is related primarily to the neurological disease responsible for the seizures. Treatment may be specific for the underlying disorder (e.g., glucose or calcium) or less specific (i.e., therapy with anticonvulsant drugs). Prompt control of the seizures is important to avoid brain injury secondary to the effects of the seizures on ventilation, perfusion, and brain metabolism. Hypoxic-ischemic encephalopathy in the newborn most often is a consequence of intrauterine asphyxia. Diagnosis depends primarily on recognition of the clinical syndrome but also on a variety of neurodiagnostic techniques, including radionuclide and CT brain scans. Prognosis is estimated best by a combination of clinical analysis and specialized neurodiagnostic studies. management is based principally on vigorous support, particularly of ventilation and perfusion, maintenance of adequate glucose influx, and control of seizures. Intraventricular hemorrhage is the most common type of neonatal intracranial hemorrhage. The neuropathology is characterized by bleeding from capillaries of the subependymal germinal matrix. Secondary rupture of the ependymal lining then causes intraventricular hemorrhage. Pathogenesis relates to the anatomy of the germinal matrix, the distribution and regulation of cerebral blood flow, and the structure and vulnerability of periventricular capillaries. Precise diagnosis requires a brain imaging procedure; portable, real-time ultrasound is the preferred approach for critically ill infants. Prognosis relates to the severity of the hemorrhage as well as any preceding hypoxic-ischemic insults and the subsequent occurrence of hydrocephalus. Choice of therapy for posthemorrhagic ventricular dilatation depends upon severity and rapidity of progression and ranges from close observation only to ventriculoperitoneal shunting.
本综述涉及新生儿惊厥、围产期缺氧缺血性脑损伤和新生儿脑室内出血。新生儿惊厥是大量新生儿神经疾病最突出的信号。惊厥现象可能很轻微。主要的病因过程是缺氧缺血性脑病。预后主要与引发惊厥的神经疾病有关。治疗可能针对潜在疾病（如葡萄糖或钙），也可能不太具有针对性（即使用抗惊厥药物治疗）。迅速控制惊厥对于避免惊厥对通气、灌注和脑代谢产生影响而继发脑损伤很重要。新生儿缺氧缺血性脑病最常见的原因是宫内窒息。诊断主要依赖于对临床综合征的识别，但也需要各种神经诊断技术，包括放射性核素和脑部CT扫描。通过临床分析和专门的神经诊断研究相结合，能最好地评估预后。治疗主要基于积极的支持，特别是通气和灌注支持、维持充足的葡萄糖供应以及控制惊厥。脑室内出血是新生儿颅内出血最常见的类型。神经病理学特征是室管膜下生发基质的毛细血管出血。随后室管膜内衬的继发性破裂导致脑室内出血。发病机制与生发基质的解剖结构、脑血流的分布和调节以及脑室周围毛细血管的结构和易损性有关。准确诊断需要脑部成像检查；便携式实时超声是重症婴儿的首选方法。预后与出血的严重程度以及之前任何缺氧缺血性损伤和随后脑积水的发生有关。出血后脑室扩张的治疗选择取决于病情严重程度和进展速度，范围从仅密切观察到脑室腹腔分流术。
