Neurological Complications and Brain Bleeds

Because we are studying the brain in Anatomy right now I thought it would be perfect to talk about brain bleeds and neurological complications in pre-mature babies.

The earlier a child is born, before 37 weeks, the higher the risk of having a brain bleed or neurological complication. The neurological system is not fully developed until 31 weeks, so if born before this point a child cannot regulate body temperature. If a child is born more than 10 weeks early the chance of having a intraventricular hemorrhage is much greater than if born less than 10 weeks early. This is because the vessel in the brain are week and fragile up until week 30, between weeks 30-40 the vessels in the brain strengthen limiting the chance of any bleeding.

Most intraventricular hemorrhaging is mild with little to no long term impacts on the child. A intraventricular hemorrhage (IVH) is not normally present at birth, but will occur within the first few days of life. This is why many times a child will be held in the NICU if they are at a higher risk for IVH to that it can be properly treated by a doctor. Normally a child will not get an intraventricular hemorrhage after the first month of life because the vessels within the brain are becoming stronger. There are four different types or levels of IVH which are called grades. Grades 1 and 2 are small bleeds that normally case no long term neurological damage or complications and in some cases can naturally be resolved on its own. Grades 3 and 4 are more serious bleeds that cause pressure on the brain or leakage into the tissue of the brain. If this occurs, blood clots may form and cause the flow of cerebrospinal fluid to be blocked. Another side effect can be the build up of fluid in the brain.

If a child has Respiratory Distress Syndrome, abnormal blood pressure, blood disorder, or other medical conditions present at birth there is a higher risk of IVH. At the time of birth doctors will asses the child and look for any indicator of a brain bleed or neurological complications. There are many different symptoms that a doctor will look for including: excessive sleeping or lethargy, decrease in muscle tone and reflexes, changes in blood pressure or heart rate, breathing problems such as apnea, a weak suck or a hard time feeding, and seizures or other abnormal body movements. If the child was born before 30 weeks doctors will do an ultrasound of the head to look for any indications of a brain bleed. The test is usually done one-two weeks after birth to see if there are clear indicators of a bleed. Many times a second and third test will be done if a child has symptoms. Doctors may also do an ultrasound at the expected due date to see if there is any remaining bleeding or other problems.

There is nothing that can be done to treat or prevent IVH from happening in a pre-mature baby. Doctors and nurses will constantly monitor the child, making sure all vitals are stable. They can also help manage any symptoms that go along with IVH. If the there is a large amount of swelling of the brain or build up of fluid doctors may preform a spinal tap to relive the pressure and fluid. A shunt may also be placed to help drain fluid as a long term solution. Depending on the case it is hard to determine the long term effects of a grade 3 or 4 IVH. Some of the most common long term effects of an ntraventricular hemorrhage are cerebral palsy and development of cognitive and motor skills.

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