The aim of management is to prevent the occurrence of a major intraventricular haemorrhage. The majority of extremely low birth weight babies have some degree of haemorrhage which usually appears within a few hours of birth, but it may be possible to prevent further bleeding by pro idling excellent supportive care. This includes control of blood pressure, of blood gases and of coagulation. The prevention of asphyxia at delivery and pf respiratory failure at any time is crucial. Active resuscitation of all very low birth weight babies at birth and elective ventilation of most of these babies has proved helpful in reducing this problem. The prevention of pneumothoraces is another factor if great importance. Episodes of deterioration associated with a pneumothorax after lead to the extension of an intraventicular haemorrhage.
Complications of intraventricular haemorrhage include shock, disseminated intravascular coagulation and pressure on parts of the brain concerned with the autonomic system, thereby influencing resporation, blood pressure and temperature control. This occurs when the blood in the ventricles clots and obstructs the flow of cerebrospinal fluid, or when the viscosity of the cerebrospinal fluid is altered because it contains debris from the haemorrhage. The results is the development of acute hydrocephalus. Drugs such as isosorbide and acetazoamide reduce the rate of cerebrospinal fluid production and may thereby reduce hydrocephalus. Regular lumbar puncture may be perfomed to relieve excess pressure. If the problem perists, the insertion of ventricular shunts may be necessary.
Another cause of long-term problems which is often associated with intraventricular hameorrhage is reduction in the white mater arbund the ventricles, that is periventricular laukomalacia which is caused by ischaemia. Weindling et al (1985) suggest that intrapartum events may predispose to the onset of periventricular haemorrhage and leukomalacia, and thus emphasize the importance of preventing perinatal hypoxia. Perivetricular haemorrhage and laukomalacia (cysts) can be diagnosed by ultrasound scanning (see Fig. 180). There is a very high incidence of spastic cerebral palsy associated with periventricular cysts (Armstrong and Norman, 1974), whereas a small confined periventricular haemorrhage .
Perdarahan Intrakranial
Ada tiga hal penting dan faktor penyebab perdarahan intrakranial yaitu prematuritas, anoxia, dan trauma. Faktor predisposisi lainya seperti anomali kongenital dari otak ataupembuluh darah otak tidak boleh diabaikan.
Cidera dapat menyebabkan kerusakan permanen, seperti perdarahan subdural atau cidera tulang bagian spinal, melalui degress kecil dari perdarahan intraventrikuler atau edema serebral yang berpengaruh secara tersembunyi di otak yang menyebabkan stroke,keterbelakangan mental, sindrom kecil kelainan fungsi otak bahkan mengganggu ingatan. Hal ini bisa ditekankan bahwa traumamempengaruhi pada pusat.
Semua area dari otak dapat terpengaruhi. Akibat yang fatal dari perdarahan subdural yang kurang umum dan perdarahan intraventrikuler adalah bentuk dari trauma yang dapat di lihat dari otopsi.
Macam-Macam Perdarahan
Perdarahan Subdural
Lesi dari trauma dapat dilihat dari masa dan preterm ( Volpe 1981 )
Tengkorak yang lunak, preterm, CPD (Cephalopelvic Disproportion), tekanan yang berlebihan dari kepala janin selama persalinan dan forsep merupakan faktor predisposisi.
