Hemorragias intracraneanas en recién nacidos prematuros / Intracranial haemorrhage in premature newborn

Se presenta la clasificación de Papile, Burstein y colaboradores, que distingue cuatro grados de estas patologías, las que con mayor frecuencia se diagnostican por ultrasonido en los recién nacidos. También se describen las características de las hemorragias subaracnoideas, subdurales y cerebelosas, y se incluyen recomendaciones para el control ecográfico.(AU)

[Ultrasonic findings of intracranial hemorrhage in preterm neonates]. / Achados ultra-sonográficos da hemorragia intracraniana em recém-nascidos prematuros.

Intracranial hemorrhage ICH is one of the most common neurological events in pre-term newborn ICH is associated with low birth weight (< 1500 g) and gestational age (GA) at delivery (< 32 weeks). The most common site affected is the germinal matrix. Papile et al. classifies it at four grades. We analyzed, prospectively, 50 newborns (27 boys) with ultrasound diagnostic of ICH; all of them were pre-term (GA < 37 weeks). They were classified according to sex, gestational age, birth weight and degree of ICH. The children were divided into two groups: A--GA < or = 33 weeks and B--34-37 weeks. In group A there were 34 children (25 boys) with mean GA of 31 weeks and birth weights average of 1308 g. In group B there were 16 children (2 boys), mean GA 34 weeks and birth weight average of 1951 g. The grades of ICH were: Group A--I-14, II-14, III-4 and IV-2; Group B--I-12, II-3 and III-1. The complications were more common in group A with 12 than group B with 4 children. The lesions happen in greatest number and most severity in children with low birth weight and younger (low gestational age). Ultrasound has shown to be effective for diagnostic and follow up of those children.

Achados ultra-sonográficos da hemorragia intracraniana em recém-nascidos prematuros / Ultrasonic findings of intracranial hemorrhage in preterm neonates

Intracranial hemorrhage ICH is one of the most common neurological events in pre-term newborn ICH is associated with low birth weight (< 1500 g) and gestational age (GA) at delivery (< 32 weeks). The most common site affected is the germinal matrix. Papile et al. classifies it at four grades. We analyzed, prospectively, 50 newborns (27 boys) with ultrasound diagnostic of ICH; all of them were pre-term (GA < 37 weeks). They were classified according to sex, gestational age, birth weight and degree of ICH. The children were divided into two groups: A--GA < or = 33 weeks and B--34-37 weeks. In group A there were 34 children (25 boys) with mean GA of 31 weeks and birth weights average of 1308 g. In group B there were 16 children (2 boys), mean GA 34 weeks and birth weight average of 1951 g. The grades of ICH were: Group A--I-14, II-14, III-4 and IV-2; Group B--I-12, II-3 and III-1. The complications were more common in group A with 12 than group B with 4 children. The lesions happen in greatest number and most severity in children with low birth weight and younger (low gestational age). Ultrasound has shown to be effective for diagnostic and follow up of those children.

A hemorragia intracraniana (HIC) é a manifestação mais comum no sistema nervoso central de recém-nascidos (RN) prematuros, especialmente os de peso menor que 1500 g, ou com idade gestacional (IG) menor que 32 semanas. O local mais acometido é a matriz germinal e é classificado em graus por Papile et al. Foram analisados prospectivamente 50 RN pré-termo (IG <37 semanas) com diagnóstico de HIC ao exame ultra-sonográfico (US) transfontanelar. Eles foram classificados quanto à idade, sexo, idade gestacional, peso ao nascer, gravidade e evolução ultra-sonográfica da lesão. As crianças foram divididas em dois grupos (A: IG < 33 semanas e B: 34> IG<37 semanas). No grupo A tivemos 34 RN (25 meninos) com IG média de 31 semanas e peso médio de 1308 g. No grupo B tivemos 16 RN (2 meninos) com IG média de 34 semanas e peso médio de 1951 g. A distribuição da HIC nos grupos foi: Grupo A-Grau I- 14, II-14, III-4 e IV-2 e Grupo B-I-12, II- 3, III-1. Não houve diferença estatística do grau da HIC entre meninos e meninas ou entre os grupos de RN. As complicações foram mais comuns no grupo A, com um total de 12, contra 4 no Grupo B. O US se mostrou método eficiente no diagnóstico e acompanhamento dos RN com HIC.