RESUMEN
The traumatic intracranial haemorrhage still remains a serious complication of instrumental deliveries with an uncertain prognosis. Regarding tentorial haemorrhage, surprisingly few clinical neurological data are available. Most of the references in literature are older case reports, associated frequently with an unfavourable outcome. We report a newborn after a serious tentorial haemorrhage with an excellent neurodevelopmental outcome. Computed tomography (CT) scan of our patient demonstrated an extensive bilateral tentorial haemorrhage extending to the foramen magnum. The newborn showed a good respiratory effort, but a neurological impairment including anisocoria, apathy, hypotonia, incomplete grasp and Moro reflex. Despite these signs, the development at 9 and 18 months of age was appropriate. The aim of this report is to accentuate that the prognosis of infants with tentorial haemorrhage should be always evaluated carefully with main respect to clinical signs. The outcome of the newborn even after a large tentorial haemorrhage can be surprisingly without a serious neurological deficit. Spontaneous breathing without support, normal blood pressure and absence of seizures are clinical indicators that may be associated with a good outcome despite an extensive tentorial haemorrhage.
Asunto(s)
Traumatismos del Nacimiento/complicaciones , Hemorragia Cerebral/etiología , Parto Obstétrico/efectos adversos , Forceps Obstétrico/efectos adversos , Traumatismos del Nacimiento/diagnóstico , Hemorragia Cerebral/diagnóstico , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , PronósticoRESUMEN
UNLABELLED: We report a case of a profoundly hypothermic newborn with a core temperature of 25 degrees C with a successful recovery and normal neurological outcome at 3 and 6 months. This term male infant had been exposed to a temperature of -3 degrees C for approximately 30 min. Slow re-warming, using external modalities was used in addition to volume expansion, heparinization, antibiotics and sedation. There is limited information available concerning the safest and most effective method of re-warming hypothermic newborns. Slow re-warming has been advocated as it replicates the normal physiological process in a neonate, which minimizes a negative therapy impact. CONCLUSION: The most significant decision regarding treatment is the identification of the most appropriate method and speed of re-warming. This report supports recommendations for gradual re-warming of a severely hypothermic newborn. Physiological cardiovascular mechanisms seemed to be intact during slow re-warming; this might be applicable to the treatment of profound hypothermia of the newborn.