[Spontaneous intracranial hemorrhage in term neonates and infants]

Twenty nine full term haemophiliac neonates and babies, aged eight months with acute intracerebral haemorrhage are reported: four babies with haemophiliac status, one with intracerebellar bleeding due to microvascular malformation, and 24 babies in whom the cause of bleeding could not be established (probably vitamin-K deficiency). Fourteen surgeries were performed in ten babies. When dramatic neurological signs of spontaneous cerebral stroke develop in a term newborn or a baby they require immediate ultrasonographic examination. This noninvasive method can be repeated without risk to disclose all changes into the bleeding focus before and after surgical treatment. Selective cerebral angiography was exceptionally recommended for detection of suspected vascular malformation. Lumbar puncture was performed in more than one third of patients to confirm subarachnoid bleeding. However, this method has not been accepted being the purposeless and risky. Pharmacotherapy should be quickly used to correct the supposed vitamin-K deficiency and for replacement of relevant missing plasma factor of the prothrombin complex. To stop bleeding and to secure surgery the replacement substitute must raise the factors' level at least by 50 percent. The treatment of choice is vitamin-K1, 1-3 mg and fresh frozen plasma 10ml/kg of body weight. The neurological recovery was in general satisfactory after the stabilization of acute clotting disorder was achieved. Eight babies died (28 percent), five of them were admitted in deep comatose state.