Hematoma formation

Introduction Blood accumulation, edema due to blood stasis. Found in neonatal head hematoma, intracranial hematoma, epidural hematoma, subdural hematoma, luteal hematoma, nasal septum hematoma. Hematoma often occurs with primary brain injury and can occur alone without significant primary brain injury.

Cause

Causes of hematoma formation

(1) Hypoxia: The fetal hypoxia in the uterus causes the blood oxygen concentration of the fetus to decrease, causing congestion and edema of the brain and meninges, and at the same time, the concentration of carbon dioxide in the fetal blood is increased, so that the permeability of the capillary wall is increased, resulting in extravasation of blood. . The development of vascular elastic fibers in immature children is not perfect. The vascular permeability increases during hypoxia, and the clotting factors decrease significantly within 1 to 3 days after birth, so the incidence rate is higher than that of full-term children.

(2) Injury: Due to mechanical damage during childbirth, such as forceps, fetal head attraction, difficulty in coming out of the breech, etc., the skull is squeezed, causing rupture of the intracranial blood vessels. In addition, if the delivery is too fast, due to rapid changes in external pressure can also cause neonatal intracranial hemorrhage.

an examination

Related inspection

General soft tissue MRI examination

Examination of hematoma formation

Clinical manifestations vary according to the location of the injury and the amount of bleeding. Clinical symptoms are characterized by successive appearances of asphyxia, excitement, and inhibition.

(1) Asphyxia : Most newborns have different degrees of asphyxia or respiratory disorders after birth, paroxysmal bruising, mainly characterized by pale asphyxia.

(B) the excitement period: a few hours after the recovery of neonatal asphyxia, vomiting, loud screaming, irregular breathing (slow or pause), swallowing swallowing reflex disappeared, followed by paroxysmal or tonic paralysis, accompanied by There are strabismus, nystagmus, drooping eyelids, fullness of the cardia, strong items, knee reflexes and shallow reflexes.

(3) Suppression period: If the condition continues to increase, it will be suppressed by excitement. However, in some patients with severe bleeding, they are pale and suffocated at birth, can be in a state of lethargy without excitement, and even coma, not eating, muscle spasm, slow breathing, weak heart sounds, irregular limbs, cold, deep and shallow The reflection disappears. The heavy one died during the coma.

During the examination, the child was found to have pale complexion, bruising lips, fast and irregular breathing, sometimes bulging from the cardia, partial neck stiffness, decreased muscle tone, and different pupil sizes or strabismus, nystagmus and drooping eyelids. B-ultrasound and CT can be used for diagnosis.

Differential diagnosis

Hematoma formation is confusing

Scalp hematoma: located under the periosteum of the parietal bone, does not cross the suture; generally 2 to 3 days after delivery, the maximum, regression time 3 to 8 weeks, the touch has a sense of fluctuation.

Scalp edema: Located in the subcutaneous tissue of the first exposed part, it is not restricted by the suture, it exists when it is delivered, and it appears 2 to 3 days after birth, and there is localized edema.

Clinical symptoms are characterized by successive appearances of asphyxia, excitement, and inhibition.

(1) Asphyxia: Most newborns have different degrees of asphyxia or respiratory disorders after birth, paroxysmal bruising, mainly characterized by pale asphyxia.

(B) the excitement period: a few hours after the recovery of neonatal asphyxia, vomiting, loud screaming, irregular breathing (slow or pause), swallowing swallowing reflex disappeared, followed by paroxysmal or tonic paralysis, accompanied by There are strabismus, nystagmus, drooping eyelids, fullness of the cardia, strong items, knee reflexes and shallow reflexes.

(3) Suppression period: If the condition continues to increase, it will be suppressed by excitement. However, in some patients with severe bleeding, they are pale and suffocated at birth, can be in a state of lethargy without excitement, and even coma, not eating, muscle spasm, slow breathing, weak heart sounds, irregular limbs, cold, deep and shallow The reflection disappears. The heavy one died during the coma.

During the examination, the child was found to have pale complexion, bruising lips, fast and irregular breathing, sometimes bulging from the cardia, partial neck stiffness, decreased muscle tone, and different pupil sizes or strabismus, nystagmus and drooping eyelids. B-ultrasound and CT can be used for diagnosis.

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